Surgical Management of Posttraumatic Temporomandibular Joint Ankylosis by Functional Restoration with Disk Repositioning in Children

Abstract

Management of temporomandibular joint ankylosis poses a challenge because of technical difficulties and recurrence. The problem is more troublesome in children because of the involvement of postoperative development of the mandible. During the process of management of temporomandibular joint ankylosis, in many cases, the authors observed that the disk may exist outside of the bone mass in posttraumatic ankylosis. On the basis of this fact, the authors' working hypothesis was that if the disk could be retained and repositioned, with limited resection of the residual stump of the ramus to maintain its height, the structure and function of temporomandibular joint could be restored to a maximum degree to provide normal function and growth in children. Ten children with temporomandibular joint ankylosis underwent this approach, in which the disk was retained and repositioned and the residual stump of the ascending ramus was preserved and reshaped to maintain its height. All patients were reviewed regularly and evaluated retrospectively. The follow-up period ranged from 17 to 52 months (average, 32.9 months). All patients had significant improvement in mouth opening and showed a distinctive improvement both in articular functionality and in symptoms. No relapse occurred and no secondary deformity in the mandible resulted. The approach described not only helps to prevent relapse of temporomandibular joint ankylosis but also takes postoperative mandible development into consideration. The authors deem that it is a good choice for surgical management of posttraumatic temporomandibular joint ankylosis in children.