Mangaluru: KMC Hospital has successfully performed a dentofacial deformity procedure correction caused by TMJ Ankylosis via Total temporomandibular joint replacement on a 10-year-old patient. Philip (name changed) had a previous history of multiple surgeries following diagnosis of ankylosis with various modalities. For the child, the medical condition had started 10 days postnatal in the form of a parotid abscess and had progressed to the current condition of ankylosis.
The full spectrum of treatment by way of multiple surgeries involved the use of ribs to promote growth in the lower jaw, creating a gap after the removal of bone at the level of joint and interposing muscle to prevent refusion. In addition to the above maneuvres, the child was also subjected to the principles of bone lengthening using distraction osteogenesis, which stems from the principles of orthopaedics by Ilizarov.
Speaking about the case, Dr Abhay Kamath, consultant, Oral & Maxillofacial Surgery, KMC Hospital, Mangaluru, said, “The child was diagnosed with MRSA (Methicilin-Resistant Staphylococcus Aureus) during the previous surgeries. It was more essential to treat MRSA and plan the surgery, which was a real challenge. After a thorough investigation, the parents were counselled regarding the role and use of Alloplastic Joint Replacement, as the child had exhausted all other treatment modalities. The joints were shipped from Atlanta, Jacksonville, USA, customized for the child, which is referred to as Patient-Specific TMJ Implants.
“After a thorough preoperative work-up with necessary precaution, which involved expert advice from teams of doctors, the child was subjected to the surgery under general anesthesia. Post operatively, we were able to achieve a mouth opening of 25mm, compared to the Nil mouth opening. In the post-operative period, rehabilitation was a challenging affair and was not a one-person outcome, but involved extensive cooperation from the child and motivation from the parents, in addition to the physiotherapy provided by the department of physiotherapy,” he said.
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Dr Anand Venugopal, regional chief, Clinical Services stated, “The surgery was the first-of-its-kind to be performed in India. We are happy to declare to have restored the child’s mouth opening. The boy is now eating well, attending school, and leading a happy life.”
The surgery was performed by Dr Abhay T Kamath who has been trained for TMJ replacements at Atlanta Jacksonville, USA at the Zimmer Biomet Academy. The surgery was planned with utmost precision using virtual-surgical planning as the planning software, helps the surgeon identify the intricacies of the case. The team members also included Dr Soundarya, Dr Panchakshari, Dr Mustafa, Dr Vasudev Das and Dr Amjad Ali.
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