Use of the suture anchor in interpositional arthroplasty of temporomandibular joint ankylosis

Abstract

The purpose of this article is to demonstrate the use of a mini suture anchor to attach the temporal myofascial flap to the head of the mandibular condyle in interpositional arthroplasty for the treatment of temporomandibular joint (TMJ) ankylosis. A 29-year-old patient, with unilateral posttraumatic temporomandibular joint osseous ankylosis and pre-operative maximal interincisal distance of 9mm, was treated by the interpositional gap arthroplasty using the temporal myofascial flap. After rotation, the flap and the TMJ capsule were attached to the lateral pole of the condyle by a non-absorbable mini suture anchor. The surgery was uneventful. On the first post-operative day, the range of motion was considerably improved, with a maximal interincisal distance of 26mm, a mandibular protrusion of 1mm and a lateral mandibular excursion of 4mm to the left and 7mm to the right. On the 20th post-operative day, the maximal interincisal distance was 30mm, protrusion 4mm, the lateral excursion to the right 7mm and to the left 5mm. On the third post-operative month, the maximal interincisal distance reached 40mm. The mini suture anchor demonstrated to be a good tool for the fixation of the temporalis myofascial flap to the condyle, also allowing with the same suture to attach the capsular tissue to the lateral surface of the condyle. The bone-anchored suture permits the restoration of a more physiologic TMJ anatomy. The treatment of TMJ ankylosis should be comprehensive; physiotherapy plays an important role in the rehabilitation period to restore the normal function.