Abstract
Treatment of temporomandibular ankylosis is challenging and frequently leads to re-ankylosis, relapse, dangerous complications and, in turn, the need for multiple operations. In this article, we present a protocol for the treatment of ankylosis of the temporomandibular joints that assumes earlier intervention with the assistance of 3D virtual surgical planning (3DVSP) and custom biomaterials for better and safer surgical outcomes. Thirty-three patients were treated due to either uni- or bilateral temporomandibular ankylosis. Twenty individuals received temporomandibular prosthesis, whereas seventeen required simultaneous 3D virtual surgical/planned orthognathic surgery as the final correction of the malocclusion. All patients exhibited statistically significant improvements in mouth opening (from 1.21 ± 0.74 cm to 3.77 ± 0.46 cm) and increased physiological functioning of the mandible. Gap arthroplasty and aggressive rehabilitation prior to temporomandibular prosthesis (TMJP) placement were preferred over costochondral autografts. The use of 3DVSP and custom biomaterials enables more precise, efficient and safe procedures to be performed in the paediatric and adolescent population requiring treatment for temporomandibular ankylosis.
Highlights
Ankylosis of the temporomandibular joint (TMJA) is an intracapsular union of the disc–condyle complex to the temporal articular surface due to fibrous adhesions or bony fusion between the condyle, disc, glenoid fossa and eminence
The ankylosis was left-sided in 15 cases and right-sided in 11 cases, and 7 cases presented bilateral TMJ ankylosis (TMJA)
Gap arthroplasty followed by extensive rehabilitation and mandible distraction provides proper settlement for the final mandible reconstruction: a custom TMJ prosthesis with or without orthognathic surgery
Summary
Ankylosis of the temporomandibular joint (TMJA) is an intracapsular union of the disc–condyle complex to the temporal articular surface due to fibrous adhesions or bony fusion between the condyle, disc, glenoid fossa and eminence. In extreme clinical situations and when it is left untreated, it may develop to the stage where the patient is unable to open their mouth [3] It is not a very common problem, especially in children; there is limited available research showing the best possible protocol for the treatment of such cases. In very young patients (aged eight years or less), treatment has to focus on restoring the masticatory function and on assuring the patency of the upper respiratory tract. This will allow the patient to breathe without a tracheostomy [5]. Regardless of the initial severity, after restoring movement of the mandible, all patients require further continuous rehabilitation, speech and orthodontic therapy and observation, including the monitoring of obstructive sleep apnoea syndrome (OSAS [8])
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