The Nuances of Temporomandibular Joint Ankylosis Surgery: Tips and Tricks.

Abstract

A plethora of surgical options have been described in the literature for the management of temporomandibular joint (TMJ) ankylosis, but one cannot subscribe to a modality that is infallible in regard to recurrence. The incidence of recurrence is attributed to poor surgical technique and poor patient compliance. This article proposes incorporation of subtle modifications into the surgical techniques that could prove to be helpful in the management and prevention of reankylosis. Twenty-one patients with TMJ ankylosis with an age range of 10-29 years (mean age 19 years) were operated, of whom six (28.5%) were bilateral and 15 unilateral (71.5%), and 14 (66.6%) had a history of previous surgery for ankylosis. The preoperative and intraoperative mean inter-incisal opening (MIO) was 4.4 mm and 43.2 mm, respectively. All patients fared well at the late postoperative evaluation at 24 months with a mean MIO of 36.9 mm. The subtle modifications address various aspects such as the adequacy of the preauricular approach, the use of a wide flame-shaped bur, the obliquity of the arthroplastic osteotomy, burnishing the residual ramal stump devoid of irrigation, temporalis muscle release and coronoidectomy, aggressive intermittent intraoperative jaw physiotherapy, mandatory use of a vacuum drain and rigorous postoperative jaw physiotherapy.