Staged management of recurrent unilateral temporomandibular joint ankylosis from childhood to young adulthood

Abstract

• Unilateral temporomandibular joint (TMJ) ankylosis presents a variety of problems, including limitation of TMJ function, asymmetric growths of the jaws, and secondary deformities of the facial features. • In this case, treatment consisted of four phases from childhood to young adulthood: Phase 1: primary arthroplasty and unilateral mandibular distraction osteogenesis; Phase 2: eruption monitoring; Phase 3: pre-surgical fixed orthodontic treatment; Phase 4: secondary arthroplasty and orthognathic surgery. • Careful sequential application of staged approach according to the severity of TMJ ankylosis and growth status of patient can improve TMJ function and facial aesthetics. The purpose of this case report was to introduce the concept of staged management of recurrent unilateral temporomandibular joint (TMJ) ankylosis using sequential application of primary arthroplasty, unilateral mandibular distraction osteogenesis (MDO), fixed orthodontic treatment, and secondary arthroplasty and two-jaw orthognathic surgery (2J-OGS) from childhood to young adulthood. A 3-year-old boy visited the clinic with a chief complaint of the right TMJ ankylosis. He exhibited skeletal Class II malocclusion, retrognathic mandible, occlusal plane (OP) cant, facial asymmetry, and mouth opening limitation (MOL). Treatment consisted of the four phases: Phase 1: During the primary dentition period, interpositional arthroplasty and unilateral MDO were simultaneously performed to correct TMJ ankylosis, MOL, OP cant, and facial asymmetry, while TMJ reankylosed with growth; Phase 2: During the mixed dentition period, eruption monitoring of the permanent teeth was performed using removable appliances, lingual arch, and Halterman appliance. Phase 3: During the permanent dentition, fixed appliance treatment was started to align the permanent teeth; and Phase 4: After completion of growth, gap arthroplasty and 2J-OGS were sequentially performed to correct re-ankylosed TMJ, OP cant, facial asymmetry, and retrognathic mandible. Total treatment duration was 13 years and 1 month. Class I canine and molar relationships and normal overbite/overjet were obtained. Treatment outcomes were well maintained for 43 months of follow-up. In case of recurrent unilateral TMJ ankylosis, careful application of staged approach according to the severity of TMJ ankylosis and growth status of patient can improve TMJ function and correct secondary facial skeletal and soft tissue deformities.