Factors Influencing Treatment Plan and Post Operative Compliance in TMJ Ankylosis Patients: A Retrospective Analysis of Long Term Post Surgical Evaluation

Abstract

Background and objective Ankylosis of the temporomandibular joint is a clinical entity significant for a maxillofacial surgeon. Since time immemorial humanity is battling with this condition which is not just disfiguring the normal anatomy of the face but severely hampers the function of mastication. In this study we have tried to evaluate and correlate various factors leading to causation of ankylosis of TM Joint along with clinical manifestation and treatment planning as well as outcomes. Study design This is a retrospective study, records of 60 patients were selected out of which 28 patients reported for recall. Based on a predefined format, patients were evaluated and correlation was looked up on various accounts such as age of occurrence and age of reporting to the surgeon, probable etiology, sex distribution, treatment modality and postoperative outcome. Results The mean age of onset or occurrence was 4-7 years of age whereas age of reporting to the clinic was 16-17 years. Highest percentage of patients had trauma as an etiology (64 %) and the lowest percentage had congenital deformity (21 %). Three surgical techniques were evaluated and compared for their post surgical mouthopening, gap arthroplasty was done in 61 %, interpositional arthroplasty in 39 % and low ramus osteotomy in 21 %. Conclusion This study was aimed at analyzing the clinical form and function of the post surgical patient reviewing the recent radiographs to analyze the surgical site. The data collected was (1) Age of occurrence and age of reporting with the deformity (2) Etiological history (3) Sex and Side predisposition (4) Procedure used for correction of deformity (5) Recall (follow up) data especially recurrence and physiotherapy. We arrived at a conclusion that mean age of occurrence of deformity was approximately 4.7 years and age at which patient reported to clinic was 16.2 years. The main etiological factor was trauma (51 %) and ear infection (21 %). 57 % patients presented with unilateral deformity, with both the sides equally effected. The effectiveness of gap arthroplasty, interpositional arthroplasty and low ramus osteotomy procedures was evaluated. Gap arthroplasty and interpositional arthroplasty were found to be effective procedures. The importance of post operative physiotherapy was emphasised yet again through this study.

Temporomandibular Joint Gap Arthroplasty in Cats

“…In humans, maxillofacial trauma is the leading cause of bony ankylosis of the TMJs (1,12). TMJ ankylosis can be seen in human pediatric patients due to trauma during the birthing process, and less commonly due to an underlying congenital condition (1,7,8,13). Some authors have suggested that traumatic injury of the TMJ in young human and animal patients can result in increased severity of ankylosis due to the excellent healing capacity noted in younger patients and due to the development of an exuberant bony callus (4,10,12).…”

“…If there is no known history of trauma, diagnostic imaging is often suggestive of historic trauma. Other differential diagnoses include infection (i.e., osteomyelitis or retrobulbar disease), a congenital malformation, or less likely, neoplasia ( 1 , 2 , 6 – 8 , 12 , 13 ). Depending on age at the time of trauma, there may be discordant maxillofacial growth or abnormal tooth eruption ( 1 , 4 , 10 ).…”

Intra- and Extra-articular Features of Temporomandibular Joint Ankylosis in the Cat (Felis catus)

“…In this cohort of cats, two cats had a history of trauma while the other three were adopted, and history of trauma remains elusive. Although other aetiol-ogies can lead to ankylosis, maxillofacial trauma is considered the most common cause (Meomartino et al, 1999;Maas and Theyse, 2007;Allori et al, 2010;Cetinkaya, 2012;Anyanechi, 2015;Kaur et al, 2015). Comparatively, in man, trauma and infection are the most common aetiological factors resulting in ankylosis (Kaur et al, 2015;Ma et al, 2015).…”

“…Although other aetiol-ogies can lead to ankylosis, maxillofacial trauma is considered the most common cause (Meomartino et al, 1999;Maas and Theyse, 2007;Allori et al, 2010;Cetinkaya, 2012;Anyanechi, 2015;Kaur et al, 2015). Comparatively, in man, trauma and infection are the most common aetiological factors resulting in ankylosis (Kaur et al, 2015;Ma et al, 2015). Inflammatory conditions such as infectious or autoimmune arthritis, irradiation, prior surgery and genetic factors are also reported in people with TMJ ankylosis (Kaur et al, 2015;Cheong et al, 2016).…”

“…Comparatively, in man, trauma and infection are the most common aetiological factors resulting in ankylosis (Kaur et al, 2015;Ma et al, 2015). Inflammatory conditions such as infectious or autoimmune arthritis, irradiation, prior surgery and genetic factors are also reported in people with TMJ ankylosis (Kaur et al, 2015;Cheong et al, 2016). In dogs, craniomandibular osteopathy may result in TMJ ankylosis (Strøm et al, 2016).…”