Simultaneous correction of temporomandibular joint ankylosis, facial asymmetry and obstructive sleep apnoea — the middle path

Abstract

Background: Temporomandibular joint (TMJ) ankylosis is a morbid condition that not only results in hypomobility of the joint but also cause considerable facial asymmetry and obstructive sleep apnoea (OSA). Many approaches have been proposed to correct these. However, the importance of a simple procedure, genioplasty, is often under estimated. Objectives: Providing a single-staged management plan for such patients to release their ankylosis, improve their symmetry and OSA. Methods: 15 patients of TMJ ankylosis age ranging from 15 to 46 years underwent release of TMJ ankylosis with simultaneous advancement genioplasty. Results included achievement of an average of 27 mm of increase in mouth opening, 8.3 mm projection, 7.1 mm translation, 38.25% increase in Pharyngeal Airway space in a mean follow up of 18.5 months (range 6–32 months). Results: Simultaneous genioplasty performed with TMJ ankylosis release serves to improve mouth opening and hence restore function, correct facial asymmetry although not completely, but significantly, reduce episodes of nocturnal desaturation and by increasing the pharyngeal airway space, provides an added advantage of subsequent ease of intubation, if secondary surgery is required. Also, genioplasty does not interfere with subsequent osteotomies. Conclusion: This treatment plan serves as a middle path between single staged addressing only TMJ ankylosis and two staged surgery considering correction of facial asymmetry following ankylosis release.