Managing the complexities of obstructive sleep apnoea syndrome, reankylosis and poor aesthetics in temporomandibular joint ankylosis — an experience of 18 years in the Indian population

Abstract

Background: Temporomandibular joint (TMJ) ankylosis is a complex disorder, the problems associated with it can be multiple e.g. difficulties in mastication, speech, poor nutrition, poor oral hygiene, malocclusion, compromised airway, poor aesthetics and recurrence. All of these invariably result in the physical and psychological disability of the patient. Management of TMJ ankylosis is challenging, being associated with intraoperative risks, rehabilitation difficulties and chances of recurrence. Though its treatment has been discussed in the literature for over 200 years, no single technique has produced long-term successful outcomes. In a clear understanding TMJ ankylosis is not a neoplastic disease yet recurrence rates as high as 25% are reported in long-term studies. Objectives:1.To introduce new reforms and modifications in the existing surgical procedures for prevention of reankylosis.2.To discuss the timing and importance of distraction for obstructive sleep apnoea (OSA) to prevent reankylosis and its role in rehabilitation with or without genioplasty.3.To highlight the role of dermis fat as an interpositional material.4.To introduce a system of classification for recurrent ankylosis for planning the treatment modality.5.To scrutinise reasons for reankylosis with old protocols and report the success of new protocols that were used to suit the Indian population for the economically backward population. Methods: A retrospective statistical analysis and scrutiny of a total of 125 patients of ankylosis over 18 years who received treatment with old (33 cases) and new protocols (48 cases) and further revised protocol (23 cases) with recent new reforms was carried out. Conclusions: Based on our clinical experience with the introduction of new reforms and the adaptation of modified protocols we were able to achieve a drastic reduction in the recurrence rates from 18.1 to 5.8% to nil, besides minimising the postoperative adverse sequel, correcting OSA and improving aesthetics with distraction osteogenesis.