Comparison of interpositional arthroplasty using dermis fat graft with gap arthoplasty (GA) in the management of temporomandibular joint ankylosis

Abstract

Background: Over the past 150 years, much has been said and done as far as temporomandibular joint (TMJ) pathologies are concerned, of particular importance is TMJ ankylosis. It is an age old affliction that causes problems in mastication, digestion, speech, function, cosmesis, and maintenance of oral hygiene. Today, both gap arthoplasty (GA) and interpositional arthroplasty (IA) have become the acceptable standards for the primary surgical management of TMJ ankylosis. Objectives: We compared GA with IA using dermis fat with our primary outcome as maximal mouth opening, and secondary outcomes as pain during mouth opening, fate of the dermis fat graft and patient satisfaction. Methods: Twenty patients with clinical and radiological diagnosis of TMJ ankylosis were randomly divided into two groups. One group underwent GA while the other group received dermis fat as an interpositional material. Both groups were followed up to two years and maximum mouth opening was recorded. Additionally, magnetic resonance imaging was done for dermis fat group to calculate the volume of the graft. Findings: The mean mouth opening after one year of follow-up was 37.4 and 38.9 mm in IA and GA group respectively. No significant difference was found between the two groups (P < 0.05). Conclusion: Both the modalities are successful in surgical management of TMJ ankylosis. However, clinically, compliance of the dermis fat group in jaw exercises was found to be better than the gap arthroplasty group as suggested by lower pain scores in this group.