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Case ID:1039 19 y.o. Female |
TMJ Disorders : Cranium |
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Chief Complaint: | Chronic left facial pain |
| Relevant History: | Facial trauma age 10, fell of bike, hit face. Subsequent multiple episodes of jaw locking. Bilateral TMJ disc repairs 1993. Left TMJ discectomy and temporalis flap 1994. No improvement left TMJ. | |
| Diagnosis: | Left TMJ degenerative joint disease. Mandibular retrognathism. Wilkes Classification IV | |
| Surgery Date: | October 31 1995 | |
| 1. Left TMJ total joint reconstruction. 2. Mandibular sagittal split advancement osteotomy. 3. Chin advancement osteotomy. The intra-oral sagittal split osteotomy was completed and the patient placed into IMF. A chin advancement osteotomy was completed and the fragment secured with a 2.0 mm bone plate. Surgery was then directed to the left TMJ. A left TMJ arthroplasty was completed, removing the remnants of the disc and the residual scar tissue from the fossa and eminence. A condylectomy was performed at the level of the sigmoid notch. A Christensen fossa eminence prosthesis was fitted and secured to the lateral rim of the fossa. A full metal custom Christensen condylar prosthesis was fitted and secured to the lateral surface of the ramus. The condylar head was positioned without contact into the fossa prosthesis with approximately 2mm of interpositional space. The IMF was released and the patient placed into heavy elastics for two days and then light elastics for two weeks post opoeratively. The patient tolerated the procedure well and was discharged on the second postoperative day. A regimen of jaw exercises was begun on the third postoperative day. | ||
| Outcome: | Four months post op: excellent progress, significantly reduced pain, improved quality of life and ability to chew. | |
| Complications: | None | |
| Visual Analog Report Rank: 0 - 10; 0 = none, normal, no restrictions; 10 = worth possible effect |
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| Before Treatment | Less than 1 Year | Greater than 1 year | |
| Headache | 9 | 2 | . |
| Facial Pain | 10 | 2 | . |
| TMJ Pain | 9 | 1 | . |
| Restriction of Jaw Movement | 8 | 3 | . |
| Dietary Restrictions | 8 | 5 | . |
| Disability | 10 | 3 | . |
| Neurologic Deficit Rank:0=None, 1=Mild, 2=Moderate, 3=Severe |
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| Before Treatment | Less than 1 Year | Greater than 1 year | |
| Motor III | 0 | 0 | . |
| Motor IV | 0 | 0 | . |
| Motor V | 0 | 0 | . |
| Motor VI | 0 | 0 | . |
| Motor VII | 0 | 0 | . |
| Sensory V | 2 | 0 | . |
| Sensory VIII | 0 | 0 | . |
| Sensory IX | 0 | 0 | . |
| Other | NE | NE | . |
| Cranio-Cervical Pain Rank:0=None, 1=Mild, 2=Moderate, 3=Severe |
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| Before Treatment | Less than 1 Year | Greater than 1 Year | ||||
| Right | Left | Right | Left | Right | Left | |
| Temporalis | 2 | 3 | 0 | 1 | . | . |
| Masseter | 1 | 3 | 0 | 1 | . | . |
| Lateral Pterygoid | 3 | 3 | 1 | 1 | . | . |
| Medial Pterygoid | 3 | 3 | 1 | 1 | . | . |
| Cranio-Cervical | 2 | 2 | 0 | 0 | . | . |
| Posterior-Cervical | 2 | 2 | 0 | 0 | . | . |
| Sternocleidomastoid | 1 | 1 | 0 | 0 | . | . |
| Atlanto-Occipital | 3 | 2 | . | |||
| Temporo-Mandibular
Joint Rank: 0=None, 1=Mild, 2=Moderate, 3=Severe |
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| Before Treatment | Less then 1 Year | Greater then 1 Year | ||||
| Right | Left | Right | Left | Right | Left | |
| Tenderness/Pain | NE | NE | 0 | . | . | . |
| Click/Pop/Creps | 0 | 0 | 0 | 0 | . | . |
| Condylar Translation Palpable | 0 | 0 | 0 | 0 | . | . |
| Condylar Translation Symmetrical | NE | . | . | |||
| Range of Movement | ||||||
| Opening with Pain (mm) | 40 | . | . | |||
| Opening without Pain (mm) | 30 | 31 | . | |||
| Right with Pain (mm) | NE | . | . | |||
| Right without Pain (mm) | 10 | 1 | . | |||
| Left with Pain (mm) | 5 | . | . | |||
| Left without Pain (mm) | NE | 9 | . | |||
| Deviation on Opening | left | none | . | |||
| Facial Morphometric | |||
| Before Treatment | Less than 1 Year | Greater than 1 Year | |
| Inner Canthus (mm) | 35 | 35 | . |
| Alar Base (mm) | 30 | 30 | . |
| Upper Face Height (mm) | 48 | 48 | . |
| Lower Face Height (mm) | 68 | 70 | . |
| Lip Length (mm) | 18 | 18 | . |
| Upper Incisor to Upper Lip (mm) | 6 | 6 | . |
| Lip Incompetence (mm) | 10 | 0 | . |
| MidLine Deviations (Skeletal) | none | none | . |
| Midline Deviations (Dental) | none(NE mm) | none(NE mm) | none(. mm) |
| Facial Profile | convex | straight | . |
| Mandible | Retrognatic | Orthognatic | . |
| Maxilla | Orthognatic | Orthognatic | . |
| Intraoral | |||
| Before Treatment | Less than 1 Year | Greater than 1 year | |
| Overjet (mm) | 6 | 3 | . |
| Overbite (mm) | 6 | 3 | . |
| Openbite (mm) | 0 | . | . |
| Occlusion (Molar) | Angle ClassII | Angle Class I | . |
| Occlucsion (Cuspid) | Angle Class II | Angle Class I | . |
| Posterior Occlusal Support | good | good | . |
| Dental Status | fair | fair | . |
| Periodontal Status | fair | fair | . |
| Intraoral Soft Tissues | normal | normal | . |
| Maxillary Alveolus Resorption | Class I | Class I | . |
| Mandibular Alveolus Resorption | Class I | Class I | . |
| Functional Occlusion | |||
| Incisor Guidance | No | Yes | . |
| Cuspid Guidance | No | Yes | . |
| Group Function | Yes | No | . |
| Balancing Guidance | Yes | No | . |
| Cephalometric Analysis | |||||
| Before Treatment | Less than 1 Year | Greater than 1 Year | Mean | Standard Deviation | |
| Skeletal | |||||
| SNA (deg) | 79 | 79 | . | 81.2 | ±3.4 |
| SNB (deg) | 73 | 76 | . | 77.6 | ±3.0 |
| ANB (deg) | 6 | 3 | . | 3.7 | ±2.0 |
| NA-Npg (deg) | 5 | 0 | . | 6.1 | ±4.8 |
| NPg-FH (deg) | 86 | 91 | . | 82.3 | ±3.4 |
| NA-FH (deg) | 92 | 91 | . | 90.0 | ±3.0 |
| N-ANS (deg) | 53 | 53 | . | 54.5 | ±6.0 |
| ANS-Me (mm) | 70 | 70 | . | 69.1 | ±5.4 |
| MeGo-FH (deg) | 27 | 23 | . | 29.0 | ±5.1 |
| NS-GoGn (deg) | 42 | 35 | . | 33.5 | ±4.8 |
| SGn-FH (deg) | 64 | 56 | . | 62.6 | ±3.9 |
| Dental | |||||
| U1-NA (deg) | 22 | 22 | . | 22.1 | ±5.8 |
| U1-(pN-A) (mm) | 11 | 4 | . | 4.2 | ±2.4 |
| U1-SN (deg) | 101 | 101 | . | 103.3 | ±5.9 |
| U1-L1 (deg) | 124 | 139 | . | 127.6 | ±10.9 |
| L1-NB (deg) | 28 | 23 | . | 26.6 | ±7.2 |
| L1-(pN-B) (mm) | 5 | 4 | . | 5.1 | ±2.7 |
| L1-(pA-Pg) (mm) | 2 | 2 | . | 2.1 | ±2.5 |
| L1-FH (deg) | 57 | 63 | . | 55.2 | ±7.0 |
| L1-GoGn (deg) | 89 | 93 | . | 95.5 | ±5.2 |
| OP-FH (deg) | 13 | 10 | . | 8.0 | ±4.0 |
| Soft Tissue | |||||
| Nasal Labial Angle (deg) | 118 | 118 | . | 110.0 | ±6.2 |
| Chin Throat Angle (deg) | NE | NE | . | 100.0 | ±7.0 |
| Pg Skeletal/Pg Soft Tissue (mm) | 11 | 10 | . | 12.5 | ±2.1 |
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