Early Treatment of Unilateral Temporomandibular Joint Ankylosis

Abstract

Ankylosis of temporomandibular joint is a condition in which partial or complete immobilization of mandible occurs because of fusion between mandibular condyle and skull base. This condition can be treated orthodontically, surgically, or therapeutically or by prosthodontic rehabilitation. A 10-year-old female patient presented to the Department of Oral and Maxillofacial Surgery, Gazi University Faculty of Dentistry, with limited mouth opening. She got injury in the face when she was 5 years old. Extraoral and intraoral examination findings were facial asymmetry on the left side, micrognathic mandible, and 19-mm mouth opening. After radiographic examination, ankylosis (Shawney type I) on the left side was revealed, and the patient was referred to Department of Orthodontics. After orthodontic clinical examination, we create following multidisciplinary treatment approach: (1) acrylic posterior bite block with spring application, (2) interpositional arthroplasty operation, and (3) physiotherapy (passive mouth-opening exercises). After the follow-up of 9 months, significant improvement (5 mm) was noticed in the opening of the mouth, and we decided to remove appliance and operate on the patient. Surgical procedure was performed under general anesthesia via blinded nasotracheal intubation. To prevent postoperative relapse, temporal fascia was interpositioned and sutured. Passive mouth-opening exercises were started 10 days after the surgery. Thirty-one-millimeter mouth opening was reached after the surgery and passive mouth-opening exercises. Patient's routine controls have been continued for 2 years.

Tratamento para disfunções temporomandibulares: uma revisão sistemática

“…The other analyzed articles were clinical case studies involving participants of both sexes (30,31,32,33,34) . These studies reported the effects of the following treatments on TMDs: myofunctional therapy (30) , global postural re-education (31) , occlusal adjustment using an orthopedic apparatus combined with electrostimulation (32) , orthodontic treatment (33) , and chiropractic combined with traditional therapy (34) . In all studies, the treatments conferred some kind of benefit to the participant, and an improvement in the signs and symptoms of TMDs were noticed.…”

Facial asymmetry, part 2. Review of treatment methods based on the literature

“…Pasywne ćwiczenia otwierania ust pacjentka rozpoczęła 10 dni po zabiegu. Kluczem do prawidłowego gojenia stawu i zapobiegania ponownej ankylozie są intensywne ćwiczenia, współpraca i sumienność chorego (18).…”

“…The patient began passive mouth opening exercises 10 days after the surgery. Intensive exercise, patient's cooperation and compliance are critical factors to proper healing of the joint and prevention of re-ankylosis (18).…”

Multidisciplinar orthopedic treatment of facial asymmetry in a pediatric patient: case report

“…A anquilose da articulação temporomandibular (ATM) é caracterizada pela fusão das superfícies articulares da articulação temporomandibular e pode ser do tipo óssea e fibrosa (Ataç, Çakir, Yücel, Gazioǧlu & Akkaya, 2014). As suas causas podem ser diversas, desde a origem traumática, que é a mais frequente, doenças sistêmicas, infecções locais e sistêmicas, trauma no nascimento devido ao uso de fórceps durante o parto, origem idiopática e também congênita (Ajike et al, 2006;Vasconcelos, Porto & Nogueira, 2008;Vieira & Rabelo, 2008;Pereira et al, 2011;Santos, Araujo, Cavalieri, Vale & Canellas, 2011;Vibhute, Bhola & Borle, 2011;Ataç et al, 2014;Limongi, Manzi & Limongi, 2019).…”

“…Outros possíveis efeitos adversos são distúrbios psicossociais ou nutricionais, sendo usual para esses pacientes optarem por dieta líquido-pastosa, além de maior incidência de cárie devido à dificuldade de realização de higiene bucal satisfatória (Vieira & Rabelo, 2008). As más oclusões são outro problema resultante dessa patologia, causadas pelo crescimento atípico da mandíbula (Vasconcelos et al, 2008;Vieira & Rabelo, 2008;Vibhute et al, 2011;Ataç et al, 2014).…”