Simultaneous treatment of temporomandibular joint ankylosis with severe mandibular deficiency by standard TMJ prosthesis

Abstract

Temporomandibular joint (TMJ) ankylosis is a refractory disease that is difficult to predictably treat. This study evaluated the prognosis of using standard alloplastic TMJ prostheses for the treatment of TMJ ankylosis in Chinese patients with severe mandibular deficiency. Patients treated from 2013 to 2015 were reviewed. The computer-aided design and manufacture (CAD/CAM) technique was used to guide bony mass removal and locate the TMJ prosthesis (Biomet, USA). Eleven patients were included in this study. All prostheses were successfully installed and stabilized intraoperatively. In 4 patients with severe mandibular deficiency, their mandibular ramus was elongated by the TMJ prosthesis and 2 patients were combined with Le Fort I osteotomy guided by digital templates. Their mean chin advancement was 10.19 mm. Their SNB and ramus heights were also significantly improved after operation (P < 0.05). There was no prosthesis loosening, breakage, or infection leading to removal after a mean follow-up period of 22 months (range, 12-31mos.). Mouth opening was significantly improved from 5.5 mm preoperatively to 31.5 mm postoperatively. TMJ reconstruction with standard alloplastic prosthesis is a reliable treatment for ankylosis, especially in recurrent cases. By CAD/CAM technique, it can correct jaw deformities simultaneously and produce stable results.

Treatment of Ankylosis in Children Associated With Osteogenic Distraction: Literature Review and Case Report

“…The classification of ATM ankylosis is a reasonable guide to choosing a treatment method. According to Yang's classification 16 , based on the reconstruction of coronal computed tomography, there are two types of ankylosis: with or without residual condyles. In ankylosis with residual condyles presenting laterally the bone fusion, the residual condyle should be maintained during surgery and only the lateral bone mass should be removed (TMJ lateral arthroplasty).…”

“…There are standardized prostheses, but they are little used since the customized prostheses are available and are much easier to be implanted intraoperatively. In order to make the bone suitable for prostheses accurately, a computer-aided technique is used to guide the bone trimming and prosthesis implantation [16,19,21].…”

“…Hu YH et al, [16], reported a clinical study where 11 adult patients underwent the treatment of TMJ ankylosis with alloplastic prosthesis reconstruction. The mean age was 45 years (27 to 62 years).…”

“…Compared with autogenous bone grafts, the prosthesis has advantages such as stability and exclusion of morbidity at the donor site, which reduces surgical trauma and shortens operative time. Another advantage of alloplastic prostheses is the low rates of ankylosis recurrence compared to autogenous grafts [14][15][16][17].…”

“…In relation to the face the patient is generally described as "bird profile", where the lower third of the face is considerably shortened and the deficient mandible is visibly retruded, the cervical angle is obtuse and the nasolabial angle is more open than normal [3,4,16]. The face is asymmetrical with the chin significantly diverted to the affected side.…”