Temporomandibular joint ankylosis: Surgical treatment and long-term results

The study reports the authors' experience in managing temporomandibular joint (TMJ) ankylosis in Chennai, India (1995-2006 and compares the surgical modalities used. Forty-five patients (67 joints) were reviewed in this retrospective study. Pre-and post-operative assessment included history, radiological, physical examination, and range of mouth opening. Age, gender, aetiology, joint(s) affected, surgical modality, complications and follow-up periods were evaluated. Various types (fibrous, fibroosseous and bony) of TMJ ankylosis were diagnosed. Trauma was the commonest aetiology. The patients' age range was 2-50 years, 51.1 % were males and the follow-up period ranged from 14 to 96 months. Average mouth opening was significantly increased to 32 mm 12 months post-operatively. Mouth opening was compared following different interpositional materials like temporalis interpositioning (33 mm), costochondral graft (30.6 mm) and autograft (30 mm). Minor and major complications were encountered in 37.4 % of cases, including 6.7 % recurrence rate. Early release of TMJ ankylosis; reconstruction of the ramus height with distraction osteogenesis or bone grafting combined with interpositional arthroplasty, followed by vigorous physiotherapy is a successful strategy for the management of TMJ ankylosis.

Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Autogenous Reconstructive Modalities of TMJ Ankylosis-A Retrospective Analysis of 45 Cases

Kumar

Rajan²,

Raman

et al. 2013

“…A case of bilateral ankylosis of longstanding duration and age of occurrence in early childhood (before growth) would Chart 3 Surgical procedures typically present with ''Andy Gump'' or Vogelgesicht deformity where the upper anterior teeth are proclined, there is severe mandibular retrognathia and retrogenia and since surrounding tissues continue to grow normally, double chin effect is classically present [7][8][9]. Additionally one also sees varying degrees of difficulty in speech, mastication and minimal mouth opening, occlusal derangement and poor oral hygiene.…”

Section: Literature Review and Discussionmentioning

confidence: 99%

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

Kaur

Krishnan

Sharma³

2014

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.

“…The causative factors of TMJ ankylosis are trauma, systemic and local inflammatory conditions, neoplasm in TMJ area. Ankylosis can be relieved by surgical treatment [32,33].…”

Section: Introductionmentioning

confidence: 99%

A Retrospective Study of Temporalis Muscle and Fascia Flap in Treatment of TMJ Ankylosis

Guruprasad

Chauhan

Cariappa

2010

Background This study sought to determine the efficacy of interpositional arthroplasty with temporalis muscle and fascia flap in the treatment of unilateral temporomandibular joint (TMJ) ankylosis in adults. Methods This retrospective study of nine cases evaluated the postoperative results of interpositional arthroplasty on temporalis muscle and fascia flap in adults. The operative protocol for unilateral TMJ ankylosis entailed (1) resection of ankylotic mass, (2) intraoral ipsilateral coronoidectomy, (3) contralateral coronoidectomy when necessary, (4) interpositional tissue transfer to the TMJ with temporalis muscle, fascia flap, and (5) early mobilization, aggressive physiotherapy. Results The study evaluated nine patients with follow-up checks from 13 to 31 months (mean 18.3 months). Patients had a preoperative maximal interincisal opening of 9-19 mm (mean 11.7 mm). During the last follow-up observation after surgery, the patients had a maximal interincisal opening of 35-40 mm (mean 38.3 mm).The results of this protocol were encouraging, the functional results of interpositional arthroplasty on temporalis muscle and fascia flap were also satisfactory. Conclusion The findings of this study support the use of temporalis muscle and fascia flap in adult patients with unilateral TMJ ankylosis. Early postoperative initial exercise, physiotherapy and strict follow-up play an important role in preventing postoperative recurrences.