Triad of temporomandibular joint ankylosis, micrognathia and obstructive sleep apnoea: A systematic review of surgical management

Abstract

Complex functional issues arising from temporomandibular joint (TMJ) ankylosis are associated with the abnormal mandibular growth secondary to condylar-glenoid fossa and its surrounding structures. These include severe limited mouth opening, micrognathia, mandibular asymmetry and obstructive sleep apnoea (OSA) which necessitate effective treatment to allow optimum functional rehabilitation. This article aims to present a comprehensive systematic review on the surgical strategy for patients presented with triad of TMJ ankylosis, micrognathia and OSA via a systematic literature search via PubMed, Google Scholar and Scopus using PRISMA guidelines. The outcomes of interest were difference in maximum mouth opening, incidence of reankylosis, amount of mandibular advancement, posterior airway space, pre- and post-operative apnoea/hypopnea index and arterial oxygen saturation as well as changes in other cephalometric or polysomnographic variables. Thirty four studies involving 360 patients were included in this review. Surgical intervention reported includes distraction osteogenesis (DO), TMJ ankylosis release and mandibular advancement, simultaneous arthroplasty and DO, pre-athroplasty DO, as well as post-arthroplasty DO. Most studies reported functional post-intervention mouth opening, with re-ankylosis reported in 4 studies. Mandibular advancement achieved was between 6mm to 34 mm. All studies reported improvement in various polysomnographic variables measured. In conclusion, the systematic review was conducted based on low level of literature evidence. Even though various surgical strategies in TMJ ankylosis have been reported, effective case-specific management of TMJ ankylosis with micrognathia and OSA requires comprehensive assessment and careful consideration of surgical options that promote mandibular advancement and airway improvement.