Abstract
Temporomandibular joint (TMJ) ankylosis is defined as fibrous or bony fusion of the mandibular head of the condylar process and the mandibular fossa of the squamous part of the temporal bone. Ankylosis of the TMJ may be intraarticular, extraarticular, or both. The objective of this report is to describe the surgical planning, technique, and outcome of gap arthroplasty for extensive TMJ ankylosis in cats. Client-owned cats (n = 7) were examined clinically and surgical planning included the use of cone-beam computed tomography (CBCT) and tridimensional (3D) printed models. In six of the seven cats, temporary tracheostomy intubation was required. Gap arthroplasty included zygomectomy, coronoidectomy, condylectomy, as well as fossectomy (removal of the mandibular fossa of the temporal bone) and was performed using a piezosurgical unit. In all seven cats, gap arthroplasty was performed without surgical complications. In addition, a clinically acceptable mouth opening was achieved in all cases. However, a noticeable mandibular instability was observed. Medium-term follow-up demonstrated acceptable quality of life with one case of recurrence of ankylosis requiring repeated bilateral surgery, and a second case with recurrence of ankylosis not requiring surgical intervention at the time of manuscript preparation. We concluded that TMJ gap arthroplasty in cats is a salvage procedure indicated in cases of severe intraarticular and extraarticular ankylosis. Diagnostic imaging by means of CBCT and 3D printing are essential for precise surgical planning. The use of a piezosurgical unit allows for safe and precise ostectomy. Clinically, despite the resulting mandibular instability, appropriate prehension of food and water was possible.
Highlights
Temporomandibular joint (TMJ) ankylosis and pseudoankylosis is an uncommon but severely debilitating condition that can be seen in various species [1,2,3,4]
All cats experienced a severe restriction in opening of the mouth which was subsequently treated with gap arthroplasty (Table 1)
Cat #5 was noted to have 18 mm of mouth opening, the least restricted of all cats
Summary
Temporomandibular joint (TMJ) ankylosis and pseudoankylosis is an uncommon but severely debilitating condition that can be seen in various species [1,2,3,4]. TMJ ankylosis is defined as fibrous or bony fusion of the mandibular head of the condylar process and the mandibular fossa of the squamous part of the temporal bone. Ankylosis can be TMJ Gap Arthroplasty further defined as intraarticular, extraarticular, or a combination of both [4, 6, 9]. Intraarticular ankylosis involves destruction of the fibrocartilaginous disc, narrowing of the joint space, and flattening of the mandibular head [9]. Extraarticular ankylosis may be termed “pseudoankylosis” due to mechanical obstruction or fusion of bones surrounding the joint [4, 6]. Severe cases have a combination of intraarticular and extraarticular ankylosis [9]
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