Management Of Temporomandibular Joint Ankylosis Research Articles

The role of physiotherapy interventions in the management of temporomandibular joint ankylosis: a systematic review and meta-analysis

BackgroundThe main aim of this systematic review and meta-analysis was to identify peer-reviewed scholarly journal articles reporting the significance of physiotherapy interventions in managing TMJ ankylosis. In addition, this study aimed to critically appraise the existing evidence on the prevalence and clinical presentation, physiotherapy intervention approaches, efficacy of physiotherapy interventions, adverse effects, and safety of physiotherapy interventions in TMJ ankylosis management.MethodsAn all-inclusive literature search was conducted using the PubMed, Google Scholar, and Scopus electronic databases. The researchers screened the potential articles and assessed for eligibility based on the reported inclusion and exclusion criteria. The quality evaluation tool for observational cohort and cross-sectional studies developed by the National Institutes of Health (NIH) and the Cochrane Collaboration's Risk of Bias Tool were used to assess the quality of the included studies. Researchers also comprehensively analyzed the data, reported the results, and discussed them according to the predominant themes.ResultsThe primary electronic database search yielded 409 articles, of which 25 were included in this review. A secondary search was conducted from citations of the included studies, yielding 74 articles, of which six were included in the study. A significantly higher prevalence of bony ankylosis than fibrous ankylosis, with an overall effect size of p < 0.00001. In addition, there were significantly more unilateral than bilateral presentations with an overall effect size of p < 0.00001. Moreover, there were 78 reported complications out of 245 subjects according to five included studies demonstrating a significant effect size with p = 0.001 following the treatment protocols.ConclusionThis study highlighted the prevalence of bony ankylosis in temporomandibular joint ankylosis, emphasizing its impact on patients' well-being. On the other hand, the results show that physiotherapy is essential to optimize postoperative outcomes and minimize adverse events such as re-ankylosis. Practitioners and healthcare professionals must monitor postoperative recovery and ensure strict adherence to physiotherapy protocols for optimal outcomes.

Management of temporo-mandibular joint ankylosis using different surgical approaches.

Comparison of gap arthroplasty (GAP), interpositional arthroplasty (IAP) and distraction osteogenesis (DO) simultaneous with interpositional arthroplasty (DO+IAP) in management of TMJ ankylosis is of interest to dentists. The study comprised 36 individuals with TMJ ankylosis, 16 of whom were female and 20 of whom were male. Both prior to and following surgery, the maximum inter-incisal opening (MIO) and facial pattern were noted. The postoperative MIO was 33.23 ± 1.23mm, 35.24 ± 1.11mm and 38.24 ± 1.34mm in GAP, IAP and DO+IAP respectively. Data is statistically significant with high MIO observed in DO+ IAP technique and low MIO in GAP technique (p < 0.005). In addition to lengthening the mandible, concurrently processed interpositional arthroplasty alongside DO for TMJ ankylosis corrects gross asymmetry of the face, occlusal mal-alignment, midline change, and creates room for previously un-erupted teeth to emerge.

Comparative evaluation of temporal fascia and dermal fat graft in the management of temporomandibular joint ankylosis.

Temporomandibular joint (TMJ) ankylosis is a debilitating condition usually afflicting children and young adults, causing long-term functional, aesthetic, and severe psychological impacts on the lives of these patients. To compare the postoperative outcomes after using one of the most commonly employed inter-positional graft, i.e., temporalis fascia, and a recently introduced 'more suitable' graft, i.e., dermal fat. A prospective study in which 20 patients of TMJ ankylosis were randomly assigned into two groups of 10 patients each. Temporalis fascia was used as an inter-positional graft in one group, while dermal fat graft was used in the other group. Post-surgical clinical parameters were evaluated, including interincisal mouth-opening and pain. Interincisal mouth opening at six months was greater in group A (32.1 ± 12.93) as compared to group B (33.8 ± 4.89), but statistically, it was not significant (P = 0.478). The mean pain score in group A was 4.60 ± 1.17, 1.50 ± 0.70, 0.20 ± 0.42 on day 1, 7, and 15, respectively. The mean pain score in group B was 4.10 ± 0.99, 1.30 ± 0.48, 0.20 ± 0.42 on day 1, 7, and 15, respectively. Both the graft materials work well in terms of maximum interincisal opening. For more clarification, a larger sample size with a longer duration of follow-up is needed to validate the study.

Management of temporomandibular joint ankylosis in children with their surgical risk and benefits

Aim: To Overview and analyse the various treatment options and risk &amp; benefits used for management of ankylosis in growing children. Summary: A Number of technique have been used for the treatment of temporomandibular Ankylosis. Since it is a known challenging problem in paediatric patients. Main aim of our treatment is excision of ankylotic mass followed by recontouring of the joint.

Management of Bilateral Temporomandibular Joint Ankylosis and Class 2 Malocclusion in a Patient With Nager Syndrome

Nager syndrome is a rare hereditary syndrome characterized by severe mandibulofacial and pre-axial upper limb anomalies. Patients with Nager syndrome often exhibit syndromic Pierre-Robin sequence secondary to their hypoplastic mandible and require mandibular distraction osteogenesis to prevent dependence on a tracheostomy or gastric tube. This procedure, however, has been associated with temporomandibular joint (TMJ) ankylosis. TMJ ankylosis is a highly debilitating condition that dramatically impairs patients’ function and can result in facial asymmetry in affected children during periods of rapid facial growth. Surgical intervention is warranted in patients who fail physiotherapy; however, there is no gold standard treatment for surgically correcting TMJ ankylosis in patients with Nager syndrome. Herein, we detail the surgical management of TMJ ankylosis and class 2 malocclusion in a patient with Nager syndrome.

Clinical study of temporomandibular joint ankylosis &amp; its management

Introduction: TMJ ankylosis is one of the problem at OGH and a challenge both to the Anesthesiologist and the surgeon. Aim: To study the etiology, occurrence in relation to age, sex, side and severity & choice of management of Temporomandibular joint Ankylosis and their outcome. Methodology: This is a study of the cases, which numbered about 15 cases, has been operated in the Department of Plastic Surgery at Osmania General Hospital between 2011 to 2015 and 2017 to 2018 in association with department of Radiology and department of Oral Medicine . The Epidemiology, Causes and Management of Temporomandibular Joint Ankylosis and Outcome are studied in all patients. All these patients had clinical and radiological evidence of bony ankylosis with minimal inter incisor distance pre-operatively. Results: In the present study, the age of presentation in this study was between 10 and 35 years with commonest age being second decade. In this study TMJ Ankylosis was common in females. (female: male=2:1). Childhood trauma was the major cause. Unilateral involvement was more common (5:1) and frequently on left side. Most of the patients presented to the hospital when the mouth opening dropped below 0.5 cm. All the patients were intubated successfully with awake blind nasal intubation. All the patients were routinely extubated when patient was stable. In this study Acrylic ball interpositional arthroplasty in adults was the procedure of choice with no major complications. Average mouth opening achieved in this study was 36mm. Early postoperative physiotherapy with molar bite blocks & active chewing exercises and follow-up is mandatory to prevent recurrence. No recurrence was noticed in this study group. Conclusion: The primary objective of adequate mouth opening which is long lasting is achieved in this series.

Classification and surgical management of temporomandibular joint ankylosis: a review.

The paper reviews various classifications and surgical techniques for the treatment of temporomandibular joint ankylosis. PubMed, EBSCO, Web of Science, and Google Scholar were searched using a combination of keywords. Articles related to classification, resection-reconstruction of the temporomandibular joint, and management of airway obstruction were considered and categorized based on the objectives. Seventy-nine articles were selected, which included randomized clinical trials, non-randomized controlled cohort studies, and case series. Though several classifications exist, most classifications are centered on the radiographic extent of the ankylotic mass and do not include the clinical and functional parameters. Hence there is a need for a comprehensive staging system that takes into consideration the age of the patient, severity of the disease, clinical, functional, and radiographic findings. Staging the disease will help the clinician to adopt a holistic approach in treating these patients. Interpositional arthroplasty (IA) results in better maximal incisal opening compared with gap arthroplasty, with no significant difference in recurrent rates. Distraction osteogenesis (DO) is emerging as a popular technique for the restoration of symmetry and function as well as for relieving airway obstruction. IA, with a costochondral graft, is recommended in growing patients and may be combined with or preceded by DO in cases of severe airway obstruction. Alloplastic total joint replacement combined with fat grafts and simultaneous osteotomy procedures are gaining popularity. A custom-made total joint prosthesis using CAD/CAM can efficiently overcome the shortcomings of stock prostheses.

Alloplastic total joint replacement in management of temporomandibular joint ankylosis

Both autogenous and alloplastic material have been used in management of temporomandibular joint (TMJ) ankylosis. Second surgical site, donor site morbidity, possibility of over/undergrowth, graft fracture or resorption and increased surgical time are the disadvantages of autogenous graft. Alloplastic total joint replacement (TJR) has become a promising technique in management of adult temporomandibular joint ankylosis (TMJA). This paper intends to present the role of alloplastic TJR in management of TMJA. There is significant current evidence of the role of alloplastic TJR in the management of TMJA. Results in TMJA are excellent with sustained improvement in pain free mouth opening, correction of facial asymmetry, reduction in recurrence and improved quality of life. TMJ TJR is becoming the gold standard of care in the management of TMJA, although costs can sometime preclude access to this mode of therapy.

Strategies to reduce re-ankylosis in temporomandibular joint ankylosis patients

The purpose of the study was to define a protocol for the prevention of re-ankylosis after surgical management of temporomandibular joint ankylosis (TMJA). The investigators designed a retrospective study on all TMJA patients treated with different treatment modalities from 2013 to 2019. The investigators observed that complete removal of the ankylotic mass particularly on the medial side; use of a piezoelectric scalpel for a clean and smooth osteotomy with copious irrigation to remove bone chips and slurry; less trauma to the local tissue; osteotomy design parallel and inferior osteotomy at the narrowest part, which mostly corresponds to the condylar neck; performance of a coronoidectomy (if mouth opening is <30mm), fat interposition; no intraoperative correction of any pre-existing chin deviation when treated with costochondral graft; patient motivation; and aggressive physiotherapy, and use of a vacuum drain are all important to prevent re-ankylosis, irrespective of the treatment modality. A total of 114 patients (n=152 joints), [bilateral (n=38), unilateral (n=76)] were evaluated retrospectively. Interpositional arthroplasty with fat was performed in n=43, CCG was used for reconstruction in n=30 and total joint replacement (TJR) was done in n=41 patients. Re-ankylosis was seen in n=3 (2.6%) patients (2 in CCG and 1 patient in interpositional arthroplasty). The follow-up ranged from 12-80 months. The results conclude that following the suggested best practice protocol is effective in reducing re-ankylosis.

Analysis for different functional results of TMJ ankylosis management by comparing ramus-condyle unit reconstruction using vertical ramus osteotomy and interpositional gap arthroplasty

The objective of the present study was to analyze the functional results of temporomandibular joint (TMJ) range; that is, trismus index, lateral excursion, protrusion, retrusion, occlusion, masticatory efficiency), reestablishment of the anatomic relationship of the TMJ, aesthetics to improve quality of life, and complications in terms of ramus shortening on the affected side, deviation, facial asymmetry, neurologic deficits, and reankylosis. Sixteen patients with unilateral bony ankylosis were included and randomly divided into 2 groups with 8 patients in each group. Group I was treated with interpositional gap arthroplasty followed by reconstruction of the ramus-condyle unit using vertical ramus osteotomy. Group II was treated with interpositional gap arthroplasty. In both groups, a pedicled flap made up of fascia, temporalis muscle, and pericranium was used as an interpositional material. The functional range of the mandible was analyzed pre- and postoperatively. Group I improved significantly more than group II in terms of TMJ range; that is, trismus index, lateral excursion, protrusion, retrusion, reestablishment of the normal anatomic relationship of the TMJ, aesthetics, and masticatory efficiency. The reestablishment of anatomic relationship showed better result in mastication significantly. No reankylosis was reported in any of the groups. The functional results and aesthetics with TMJ reconstruction are significantly better.

Controversies in the management of temporomandibular joint ankylosis using distraction osteogenesis - A systematic review

Background:The three commonly employed sequences of distraction osteogenesis (DO) in the management of temporomandibular joint (TMJ) ankylosis with dentofacial deformities include post-arthroplastic distraction osteogenesis (PAD), simultaneous arthroplastic distraction osteogenesis (SAD), and pre-arthroplastic distraction osteogenesis (PrAD).Objective:The aim of this systematic review is to compare the effectiveness of various sequences of DO in the management of TMJ ankylosis with micrognathia/and obstructive sleep apnea syndrome (OSAS).Data Sources:A comprehensive online and manual search of English language literature with no date restrictions was done on March 2020.Eligibility Criteria:Inclusion criteria were case series and prospective and retrospective studies involving adult/paediatric human subjects with unilateral/bilateral TMJ ankylosis and micrognathia/OSAS treated with DO.Study Appraisal and Synthesis Methods:Of 73 studies identified, only 10 were included in the qualitative synthesis. The outcomes assessed were as follows: maximum mouth opening (MMO), posterior airway space (PAS), polysomnography variables, reankylosis, mandibular length, and chin and mandible position.Results:All the included studies showed high risk of bias. MMO and mandibular length increased, chin and mandibular position improved by the end of treatment in all the three sequences, and polysomnography variables and PAS significantly improved in PrAD compared to PAD and improved in SAD compared to baseline. Reankylosis was significantly less in PrAD.Conclusion:More well-designed studies comparing the three sequences of DO should be carried out to arrive at a consensus.

TMJ Ankylosis: A Reveiw

Temporomandibular joint (TMJ) ankylosis is a pathologic condition where the mandiblar fusion takes placeto the fossa by bony or fibrous tissues. It interferes with normal day to day activities such as mastication,speech, oral hygiene, etc. Trauma to the chin is the most common factor of TMJ ankylosis followed byinfections. This article highlights the eitiology, clinical features, various classifications radiographic features,histopathological features and surgical management of TMJ ankylosis

Arthroplasty Followed by Distraction Osteogenesis Versus Distraction Osteogenesis Followed by Arthroplasty in the Management of TMJ Ankylosis: A Comparative Study.

To compare treatment outcome of arthroplasty followed by distraction osteogenesis (AFD) and distraction osteogenesis followed by arthroplasty (DFA) in the management of mandibular deficiencies in temporomandibular joint (TMJ) ankylosis. A total of 20 patients with TMJ Ankylosis were included in the study. Patients were randomly divided into two groups. Group 1 consisted of patients for whom arthroplasty was done prior to distraction osteogenesis (AFD) for the correction of deficient mandible. Group 2 included patients where distraction osteogenesis was performed prior to arthroplasty (DFA). The treatment outcome was assessed based on maximum interincisal distance, overjet, corpus length, ramus height, upper airway, lower airway, duration of the procedure and the complications for the treatment at the end of 3, 6 and 12months. After the treatment was ended, the patients of both groups had increase in mouth opening and appearance was improved remarkably. There was general increase in all the parameters in both the groups. But at the end of 12months, airway and the ramus height were more stable and the control of the proximal segment was superior in DFA group. Open bite was noticed in 2 cases of AFD group which was treated by elastics. There required additional surgery for the removal of distractors in the AFD Group. Establishing the airway during the surgery was easier in AFD group. The study concludes that distraction followed by arthroplasty was a better procedure for the management of TMJ ankylosis owing to its stable results and less number of surgeries.

The Application of Intraoperative Computed Tomography in Surgical Management of Temporomandibular Joint Ankylosis

To investigate the application and value of intraoperative computed tomography (CT) in the surgical management of temporomandibular joint (TMJ) ankylosis. Patients who underwent surgery of TMJ ankylosis with the aid of intraoperative CT scan from July 2016 to December 2018 were retrospectively studied. Demographics, type of ankylosis, surgical method, intraoperative CT scan time, radiographic evidence, the CT-directed revision rate, and clinical outcomes were analyzed. Four patients (5 sides) were successfully operated with the aid of intraoperative CT imaging, and CT-directed revisions were made in 3 of them during surgery. The average time spent in CT scanning was (10.2±3.3) minutes. No surgical complications were noted, and a good satisfaction rate (with an average maximum mouth opening of 38.8mm and no recurrence during the follow-up period) was obtained. Intraoperative CT scanning is a helpful tool in the evaluation of the radiographic result of TMJ ankylosis, and a real-time revision could be made. It increased the precision and safety of the surgery of TMJ ankylosis.

Modified Temporalis Myofascial Flap for Management of Temporomandibular Joint Ankylosis: JAIN Technique.

One of the management modalities of temporomandibular joint ankylosis is interpositional gap arthroplasty. The most commonly used interpositioning material is temporalis myofascial flap owing to its close proximity to operating site. However, sometimes this flap becomes insufficient in terms of length. Hence, we propose a technique of temporalis myofascial flap lengthening. The technique described in the manuscript increases the length of the flap by 1½-fold. This increases the reach of the flap till the medial aspect of the created gap avoiding bone-to-bone contact during movement of the jaw. This technique can be easily and effectively used to ensure proper interpositioning during management of temporomandibular joint ankylosis to avoid recurrence.

Immediate versus delayed physiotherapy protocol after the management of temporomandibular joint ankylosis by conservative gap arthroplasty09

Objective: The aim of this study was to evaluate the effect of immediate and delayed physiotherapy protocol on the maximum interincisal opening (MIO), pain magnitude during physiotherapy, and rate of re-ankylosis, following the release of temporomandibular joint ankylosis (TMJa) by conservative gap arthroplasty. Subjects and methods: Twenty four patients with TMJa were treated with conservative gap arthroplasty. They were divided into two equal groups: In group 1, physiotherapy was started 24 hours after surgery. In group 2, physiotherapy was initiated after one week postoperative. MIO, pain magnitude by visual analogue scale (VAS), and rate of re-ankylosis were recorded. The values of MIO and VAS of both groups were compared by paired sample t-test. Results: Both groups showed significant improvement in MIO. At one week and one month postoperative, MIO showed significant difference between the two groups (P-value ≤ 0.05). At the remaining follow-up period, no significant difference was observed. By comparing the VAS of both groups, it was significant only at the first day of physiotherapy and at two weeks (P-value ≤ 0.05). The rate of re-ankylosis was non-significant between the two groups. Conclusion: Maintenance of MIO is less dependent on the starting time of physiotherapy and more indebted to the patient cooperation with a regular physiotherapy protocol. The reduction in the VAS encourages the patients to perform more comfortable TMJ exercises.

Immediate versus Delayed Physiotherapy Protocol after the Management of Temporomandibular Joint Ankylosis by Conservative Gap Arthroplasty

Immediate versus Delayed Physiotherapy Protocol after the Management of Temporomandibular Joint Ankylosis by Conservative Gap Arthroplasty

Is There a Difference in Volumetric Change and Effectiveness Comparing Pedicled Buccal Fat Pad and Abdominal Fat When Used as Interpositional Arthroplasty in the Treatment of Temporomandibular Joint Ankylosis?

There is limited evidence in the literature about fat grafting in the management of temporomandibular joint ankylosis (TMJA). The purpose was to investigate which interpositional fat grafting technique is superior in the operative management of TMJA. The specific aim was to compare the volumetric change and maximal mouth opening (MIO) when pedicled buccal fat or abdominal fat is interposed in patients being treated for TMJA. A randomized controlled trial was conducted on TMJA patients divided into 2 groups: Pedicled buccal fat pad was used for interposition in group A, whereas abdominal fat was used in group B. At the end of 1year, the volumetric change in fat was analyzed by comparing immediate postoperative and 1-year follow-up magnetic resonance imaging (MRI). MIO and re-ankylosis were recorded. Categorical variables were analyzed by the χ2 test or Fisher exact test. Continuous variables were compared using the t test and Wilcoxon signed rank test. Linear regression analysis was performed. A total of 36 patients (51 joints [15 bilateral and 21 unilateral]) were included, comprising 18 in group A and 18 in group B. The mean preoperative MIO measured 6.8mm in group A and 4.2mm in group B. The mean immediate postoperative MRI fat volume was 4.3cm3 in group A and 10.8cm3 in group B. One-year follow-up MRI showed a fat retention rate of 32.44% in group A and 58.17% in group B. The rate of volumetric shrinkage was 67.5% in group A and 41.9% in group B (P<.001). Analysis of variance showed a statistically significant difference between volumetric shrinkage and both treatment groups (P<.001). MIO improved to 30.6mm in the pedicled buccal fat pad group (group A) and 41.9mm in the abdominal fat group (group B) (P<.001). No re-ankylosis occurred in either group at 1-year follow-up. Our study results suggest that the percentage of retention of interposed abdominal fat at 1year is more than that of pedicled buccal fat pad. Volumetric shrinkage is greater with buccal fat pad, which is a paradox considering the pedicled blood supply. Abdominal fat is better than pedicled buccal fat pad when used for interposition in TMJA treatment.

Sternoclavicular Joint Transfer in the Management of Temporomandibular Joint Ankylosis- A case report

Temporomandibular joint ankylosis is a clinical condition resulting in loss of jaw function and retardation of growth. The main objectives of the treatment for Temporomandibular joint ankylosis are to increase mouth opening, restore joint function, initiation of mandibular growth, improve the patient’s facial esthetic profile and prevent reankylosis. To release of ankylotic mass and gap is filled up with interpositional material. We reported a case of temporomandibular joint ankylosis in a 15 years old girl, whose treatment was done in the Department of Oral and Maxillofacial Surgery,Bangabondhu Sheikh Mujib Medical University, with sternoclavicular joint transfer which is very rare in our country and this was nearly fulfill treatment objective.&#x0D; Bangladesh J Otorhinolaryngol; April 2018; 24(1): 90-94

Re-Contouring Interpositional Gap Arthroplasty with Ramus Height Preservation for Treatment of Temporomandibular Joint Ankylosis: Case Report (New Technique)

Background: Ankylosis of the temporomandibular joint (TMJ) is an intracapsular union between the mandibular condylar disc and the temporal articular surface that restricts mandibular functions. The management of TMJ ankylosis requires minimally invasive methods. Objectives: This study aims to present a new surgical method for restoring ramus height as much as possible after condylectomy of the TMJ due to ankylosis. Case Prsentation: Two patients with TMJ ankylosis participated in this investigation. Patients’ preoperative maximal mouth openings were 3 mm and 9 mm. A new method was used to separate the bony fusion between the condyle and the glenoid fossa. Then, the condylar head on the mandibular ramus was recontoured, and finally the temporalis musculofascial flap was employed as an interpositional graft. Patients were followed for six months. Both surgeries were performed at the Department of Oral and Maxillofacial Surgery of Taleghani Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran. Results: Both patients had an average maximal mouth opening of 35-40 mm postoperatively. Conclusion: In patients who have TMJ ankylosis the excessive bone between the condyle and the zygomatic arch can be removed by releasing the ankylotic site followed by routine gap arthroplasty so that the ramus becomes shorter than the other side. With this method, however, the condylar head is also recontoured, thus preserving more ramus length than with other techniques; future orthognatic surgery or distraction osteogenesis (DO), if necessary, will also be easier.