Abstract
Radiotherapy at the temporomandibular joint (TMJ) area often results in trismus, however, post radiation ankylosis is extremely rare and has not been previously reported in literature. Radiation is known to impact the vasculature of bony structures leading to bone necrosis with certain risk factors including surgical intervention, even teeth extraction, that could lead to osteoradionecrosis. Accordingly, gap arthroplasty for such case seemed rather challenging. In this report, we introduce for the first time, a rare case of temporomandibular joint ankylosis post radiotherapy for management of rhabdomyosarcoma in a 12 years-old boy. A modified gap arthroplasty technique combined simultaneously with pterygo-masseteric muscle flap was applied to lower the risk of osteoradionecrosis due surgical trauma at irradiated area. Computed tomographic scan on the head indicated that the TMJ architecture was completely replaced by bone, with fusion of the condyle, sigmoid notch, and coronoid process to the zygomatic arch and glenoid fossa. The patient’s problem was totally solved with no osteoradionecrosis or relapse of ankylosis observed at follow up visits. Herein, the modified gap arthroplasty combined with pterygo-masseteric muscle flap could be recommended to be applied on other cases of ankylosis especially after receiving radiotherapy.
Highlights
Radiotherapy for the management of head and neck cancers often impacts the temporomandibular joint (TMJ) and masticatory muscles due to the close proximity of the target region and the TMJ [1,2,3]
Advances in radiotherapy for rhabdomyosarcomas have enabled promising patient outcomes, complications associated with the structures in close proximity to the irradiation areas are inevitable; in particular, the TMJ is often impacted [8]
Many surgical treatment modalities have been described for the management of TMJ ankylosis, including interpositional arthroplasty, total joint reconstruction (TJR), and gap arthroplasty [11]
Summary
Radiotherapy for the management of head and neck cancers often impacts the temporomandibular joint (TMJ) and masticatory muscles due to the close proximity of the target region and the TMJ [1,2,3] This usually results in joint dysfunction such as trismus, which is regarded as the most common late complication of radiation on the TMJ area [4, 5]. This was to ensure appropriate low-risk placement of the osteotomy line for gap arthroplasty, enabling it to be as close as possible to the right condyle to ensure enough blood supply (Figures 1A–D). At the 2-year postoperative follow-up, no bone necrosis or recurrence of restricted opening was observed, with the patient reporting satisfaction with the surgical outcome (Figures 4A–F)
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