Three-dimensional morphological changes of the temporomandibular joint and functional effects after mandibulotomy
Identifieur interne : 000024 ( Main/Curation ); précédent : 000023; suivant : 000025Three-dimensional morphological changes of the temporomandibular joint and functional effects after mandibulotomy
Auteurs : Mohammed A. Q. Al-Saleh ; Kumaradevan Punithakumar ; Manuel Lagravere ; Pierre Boulanger ; Jacob L. Jaremko ; John Wolfaardt ; Paul W. Major ; Hadi SeikalySource :
- Journal of Otolaryngology - Head & Neck Surgery [ 1916-0208 ] ; 2017.
Abstract
The midline and paramedian mandibulotomy are surgical procedures that divide the mandibular bone into two halves and disconnects the condylar heads of the TMJ from each other. This study aimed to prospectively evaluate the temporomandibular joint (TMJ) functional and morphological changes after mandibulotomy using a reconstructed 3D models of the TMJ.
Sixteen adult patients diagnosed with oral and oropharyngeal tumors with planned surgical mandibulotomy (test group, 9 patients) or transoral (control group, seven patients) treatments were included in the study. MRI and CBCT images were obtained immediately preceeding surgery and 6–8 weeks after surgery. Using the MRI-CBCT registered images, TMJ tissues were segmented at the two occasions by the same operator and 3D models were reconstructed for morphological assessment. Changes across time were measured using the volume overlap and Hausdorff distance of the disc and condyle 3D models. Disc-condyle relationship was measured using point-based and color map analysis. To assess the early functional changes, the Jaw function limitation scale (
The two-sample Hotelling T2
The quantitative assessment of the TMJ showed minimal changes of the condylar position and variable degrees of articular disc displacement associated with the paramedian split mandibulotomy. As well, limited jaw functions and vertical mouth opening were noticed more in the mandibultomy group compared to the transoral group in 6- weeks after surgery.
Url:
DOI: 10.1186/s40463-017-0184-4
PubMed: 28129794
PubMed Central: 5273832
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Three-dimensional morphological changes of the temporomandibular joint and functional effects after mandibulotomy</title>
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<author><name sortKey="Punithakumar, Kumaradevan" sort="Punithakumar, Kumaradevan" uniqKey="Punithakumar K" first="Kumaradevan" last="Punithakumar">Kumaradevan Punithakumar</name>
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<author><name sortKey="Lagravere, Manuel" sort="Lagravere, Manuel" uniqKey="Lagravere M" first="Manuel" last="Lagravere">Manuel Lagravere</name>
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<author><name sortKey="Boulanger, Pierre" sort="Boulanger, Pierre" uniqKey="Boulanger P" first="Pierre" last="Boulanger">Pierre Boulanger</name>
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<wicri:noCountry code="subfield">Alberta T6G 2E8 Canada</wicri:noCountry>
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<institution>Department of Radiology and Diagnostic Imaging,</institution>
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<author><name sortKey="Wolfaardt, John" sort="Wolfaardt, John" uniqKey="Wolfaardt J" first="John" last="Wolfaardt">John Wolfaardt</name>
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<institution>Division of Otolaryngology Head and Neck Surgery, Department of Surgery,</institution>
<institution>Faculty of Medicine and Dentistry, University of Alberta,</institution>
</institution-wrap>
16940-87 Avenue, Edmonton, Alberta T5R 4H5 Canada</nlm:aff>
<wicri:noCountry code="subfield">Alberta T5R 4H5 Canada</wicri:noCountry>
</affiliation>
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<author><name sortKey="Major, Paul W" sort="Major, Paul W" uniqKey="Major P" first="Paul W." last="Major">Paul W. Major</name>
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<institution>Orthodontic Graduate Program, School of Dentistry,</institution>
<institution>University of Alberta, 476 Edmonton Clinic Health Academy (ECHA),</institution>
</institution-wrap>
Edmonton, Alberta T6G 1C9 Canada</nlm:aff>
<wicri:noCountry code="subfield">Alberta T6G 1C9 Canada</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Seikaly, Hadi" sort="Seikaly, Hadi" uniqKey="Seikaly H" first="Hadi" last="Seikaly">Hadi Seikaly</name>
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<institution>Division of Otolaryngology Head and Neck Surgery, Department of Surgery,</institution>
<institution>Faculty of Medicine and Dentistry, University of Alberta,</institution>
</institution-wrap>
16940-87 Avenue, Edmonton, Alberta T5R 4H5 Canada</nlm:aff>
<wicri:noCountry code="subfield">Alberta T5R 4H5 Canada</wicri:noCountry>
</affiliation>
</author>
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<series><title level="j">Journal of Otolaryngology - Head & Neck Surgery</title>
<idno type="ISSN">1916-0208</idno>
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<imprint><date when="2017">2017</date>
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<front><div type="abstract" xml:lang="en"><sec><title>Background</title>
<p>The midline and paramedian mandibulotomy are surgical procedures that divide the mandibular bone into two halves and disconnects the condylar heads of the TMJ from each other. This study aimed to prospectively evaluate the temporomandibular joint (TMJ) functional and morphological changes after mandibulotomy using a reconstructed 3D models of the TMJ.</p>
</sec>
<sec><title>Methods</title>
<p>Sixteen adult patients diagnosed with oral and oropharyngeal tumors with planned surgical mandibulotomy (test group, 9 patients) or transoral (control group, seven patients) treatments were included in the study. MRI and CBCT images were obtained immediately preceeding surgery and 6–8 weeks after surgery. Using the MRI-CBCT registered images, TMJ tissues were segmented at the two occasions by the same operator and 3D models were reconstructed for morphological assessment. Changes across time were measured using the volume overlap and Hausdorff distance of the disc and condyle 3D models. Disc-condyle relationship was measured using point-based and color map analysis. To assess the early functional changes, the Jaw function limitation scale (<italic>JFLS</italic>
) and the maximum mouth opening were measured. Two-sample Hotelling T<sup>2</sup>
<italic>t</italic>
-test was performed to determine the significance of the morphological and clinical outcomes’ differences between the two groups.</p>
</sec>
<sec><title>Results</title>
<p>The two-sample Hotelling T<sup>2</sup>
<italic>t</italic>
-test showed significant differences (T<sup>2</sup>
(df1,df2) = 0.97 (5,26), <italic>p</italic>
<0.01) between the mean values of all outcomes among the 2 groups. The change in disc displacement was significantly different between the two groups (<italic>p</italic>
<0.05). However, the condylar displacement was not significantly different between the two groups (<italic>p</italic>
=0.3). The average of the <italic>JFLS</italic>
score was five times larger after mandibulotomy, and was 2 times larger after transoral surgery (<italic>p</italic>
< 0.01). Patients showed decrease in the average of the maximum interincisal mouth opening by 11 mm after mandibulotomy, and by 5.4 mm after transoral surgery.</p>
</sec>
<sec><title>Conclusion</title>
<p>The quantitative assessment of the TMJ showed minimal changes of the condylar position and variable degrees of articular disc displacement associated with the paramedian split mandibulotomy. As well, limited jaw functions and vertical mouth opening were noticed more in the mandibultomy group compared to the transoral group in 6- weeks after surgery.</p>
</sec>
</div>
</front>
<back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Uwiera, T" uniqKey="Uwiera T">T Uwiera</name>
</author>
<author><name sortKey="Seikaly, H" uniqKey="Seikaly H">H Seikaly</name>
</author>
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