Postoperative management of arthroplasty by using unique splints in almost edentulous patient

Abstract

e G t d d splint with male keys (Fig. 3) and a maxillary one with female keys that coupled to the male keys were made (Fig. 4) to establish and keep the ideal occlusion postoperatively. anagement of ankylosis of the temporomandibular joint TMJ) is difficult. Arthroplasty without interpositional grafts equires a gap of 10–20 mm to prevent reankylosis, and often esults in deviation of the mouth after shortening of the ramus nd contraction of postoperative scars. Various interposition rafts,1–3 reconstruction,1 and distraction osteogenesis4 have een used, but maintenance of space is the key to a successul arthroplasty. Interposition with a temporalis muscle flap2 nd a Matthews device arthroplasty (MDA)4 has given good esults. The flap prevents ankylosis but does not completely aintain a vertical gap. Though the Matthews device ensures he gap, it requires 2 operations. We think that treatment of nkylosis of the TMJ should ensure an ideal occlusion and equires sequential physiotherapy. Postoperatively it is particlarly important to restore mandibular function and prevent eankylosis. A 68-year-old Japanese man was referred with painless imited mouth opening, which had been getting worse for 2 ears. He had been diagnosed as having rheumatic arthritis on aematological examination, and because he had a buttonhole eformity of a phalanx of the hand. He was almost edentulous, nd preoperative maximum denture-interincisal opening was 2 mm. Computed tomography showed ankylosis between he condyle and glenoid fossa in both TMJ (Fig. 1).