Two-Stage Treatment Protocol for Management of Temporomandibular Joint Ankylosis With Secondary Deformities in Adults: Our Institution's Experience

Abstract

Treatment of adult patients with temporomandibular joint (TMJ) ankylosis and secondary deformities is a challenging problem. Although various techniques, including arthroplasties, orthognathic surgery, autogenous bone graft, and distraction osteogenesis, have been described for the management of patients with this condition, an appropriate treatment protocol has not been established. The purpose of this report is to describe a 2-stage treatment protocol, comprising TMJ reconstruction as the initial surgery, followed by orthodontic treatment, and correction of secondary deformities as the second surgery, for the management of TMJ ankylosis with secondary deformities in adults. From January 2003 to December 2009, 24 adult patients (30 joints) with TMJ ankylosis and secondary deformities underwent TMJ reconstruction as the initial surgery, followed by orthodontic treatment and correction of secondary deformities as the second surgery. Clinical outcome was assessed based on oral function, radiography, and medical photography. Patients were followed up for a minimum of 12 months to a maximum of 32 months (mean, 18.6 months). No relapse of TMJ ankylosis occurred in any patient during the follow-up period. Oral function and skeletal deformities were significantly improved in all patients. Satisfactory occlusion was achieved with the help of orthodontic treatment. Most of the patients were satisfied with the final outcome. The 2-stage treatment protocol described not only restores oral function but also improves the patient's esthetic appearance. We believe that it is a good approach for management of TMJ ankylosis with secondary deformities in adult patients.