Abstract
IntroductionTemporomandibular joint (TMJ) ankylosis is a debilitating mandibular hypomobility disorder that may be associated with serious functional and aesthetic deformities including limited mouth opening, impaired mastication and disturbances of facial and mandibular growth. The ultimate treatment goal of TMJ ankylosis is to restore altered joint mechanics, correct associated dentofacial deformities and prevent reankylosis. Presentation of caseWe present a case of a 16 year old patient who returned with excessive mandibular growth and TMJ reankylosis following treatment of TMJ ankylosis with CCGs when he was 8 years old. DiscussionVarious treatment modalities for TMJ ankylosis have been described. These include gap arthroplasty (GAP), interpositional gap arthroplasty (IPG) and/or total joint reconstruction (with autogenous costochondral grafts or alloplastic materials), and distraction osteogenesis. Costochondral grafts (CCGs) are generally preferred for the treatment of TMJ ankylosis, especially in the growing patient. Their advantages include biocompatibility, no financial cost to the patient, low donor site morbidity, and most importantly their potential for mandibular growth. The growth of the mandible is however unpredictable. ConclusionThe optimal surgical management of this complex patient with combined orthognathic surgery and total alloplastic joint reconstruction is discussed.
Highlights
Temporomandibular joint (TMJ) ankylosis is a debilitating mandibular hypomobility disorder that may be associated with serious functional and aesthetic deformities including limited mouth opening, impaired mastication and disturbances of facial and mandibular growth
Temporomandibular joint ankylosis is defined as hypomobility of the mandible resulting from fibrous or bony union of the mandibular condyle to the cranial base
Management of condylar fractures in children is challenging because injury to the joint may not be diagnosed immediately or may be missed completely until years later when there is restriction in mouth opening and TMJ ankylosis
Summary
Temporomandibular joint (TMJ) ankylosis is a debilitating mandibular hypomobility disorder that may be associated with serious functional and aesthetic deformities including limited mouth opening, impaired mastication and disturbances of facial and mandibular growth. PRESENTATION OF CASE: We present a case of a 16 year old patient who returned with excessive mandibular growth and TMJ reankylosis following treatment of TMJ ankylosis with CCGs when he was 8 years old. DISCUSSION: Various treatment modalities for TMJ ankylosis have been described. These include gap arthroplasty (GAP), interpositional gap arthroplasty (IPG) and/or total joint reconstruction (with autogenous costochondral grafts or alloplastic materials), and distraction osteogenesis. Costochondral grafts (CCGs) are generally preferred for the treatment of TMJ ankylosis, especially in the growing patient. Their advantages include biocompatibility, no financial cost to the patient, low donor site morbidity, and most importantly their potential for mandibular growth. CONCLUSION: The optimal surgical management of this complex patient with combined orthognathic surgery and total alloplastic joint reconstruction is discussed
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