Temporomandibular Joint Ankylosis In Children Research Articles

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

Aim: To Overview and analyse the various treatment options and risk & 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.

Protocol for Multi-Stage Treatment of Temporomandibular Joint Ankylosis in Children and Adolescents.

Treatment of temporomandibular ankylosis is challenging and frequently leads to re-ankylosis, relapse, dangerous complications and, in turn, the need for multiple operations. In this article, we present a protocol for the treatment of ankylosis of the temporomandibular joints that assumes earlier intervention with the assistance of 3D virtual surgical planning (3DVSP) and custom biomaterials for better and safer surgical outcomes. Thirty-three patients were treated due to either uni- or bilateral temporomandibular ankylosis. Twenty individuals received temporomandibular prosthesis, whereas seventeen required simultaneous 3D virtual surgical/planned orthognathic surgery as the final correction of the malocclusion. All patients exhibited statistically significant improvements in mouth opening (from 1.21 ± 0.74 cm to 3.77 ± 0.46 cm) and increased physiological functioning of the mandible. Gap arthroplasty and aggressive rehabilitation prior to temporomandibular prosthesis (TMJP) placement were preferred over costochondral autografts. The use of 3DVSP and custom biomaterials enables more precise, efficient and safe procedures to be performed in the paediatric and adolescent population requiring treatment for temporomandibular ankylosis.

Temporomandibular Joint Ankylosis in Pediatric Patients With Craniofacial Differences: Causes, Recurrence and Clinical Outcomes.

The authors present an institutional experience treating congenital and acquired temporomandibular joint (TMJ) ankylosis, detailing outcomes and potential risk factors of recurrence. Retrospective chart review identified patients with TMJ ankylosis (1976-2019). Clinical records, operative reports, and imaging studies were reviewed for demographics, surgical operations, and ankylosis including maximal interincisal opening (MIO) and re-ankylosis. Forty-four TMJs with bony ankylosis were identified in 28 patients (mean age at any initial mandibular surgery: 3.7; range:0-14 years). Follow-up was 13.7 ± 5.9 years. Sixteen (57.1%) patients had bilateral ankylosis; 27(96.4%) had syndromes. Nine patients had congenital ankylosis, 16 had iatrogenic ankylosis (4.5 ± 3.7 years from initial distraction osteogenesis or autologous mandibular reconstruction) referred from outside institutions in 6 instances, and 3 had post-infectious ankylosis. Patients having their first mandibular operation at a younger age had more frequent reoperations for recurrent TMJ ankylosis, although this did not reach statistical significance. Mean improvement in MIO was 21.4 ± 7.3 mm. Ankylosis recurred in 21 (75%) patients. Five patients with congenital TMJ ankylosis required gastrostomy and remained at least partially dependent. Five patients had tracheostomy at the time of TMJ ankylosis surgery: 2 were eventually decannulated and 3 required repeat tracheostomy after ankylosis recurrence and remained tracheostomy-dependent. The clinical course of TMJ ankylosis in children affected by craniofacial differences is complex and typically involves a high rate of recurrence and multiple reoperations despite initial improvement in postoperative MIO. Younger age at initial mandibular surgery and number of operations require further investigation as potential predictors of recurrent TMJ ankylosis as well as tracheostomy and gastrostomy dependence.

Conservative gap arthroplasty without interpositioning material for management of temporomandibular joint ankylosis in children: Clinical and Radiographic Outcomes in Upper Egypt

Ankylosis is one of the challenging disorders of the TMJ especially in children. Trauma, infection, and systemic diseases are the most common causes, factors common to occur in children in Upper Egypt. Unfortunately, TMJ ankylosis responds only to surgical intervention. The aim of this study was to evaluate a conservative surgical approach. Materials and Methods: In this study inclusion criteria were set and 11 children suffering from ankylosis enrolled for the most conservative gap arthroplasty without interpositioning material and with postoperative physiotherapy protocol. The patients were evaluated clinically and radiographically for 24 months postoperatively regarding mouth opening and recurrence. Results: trauma was the main etiologic factor and bony ankylosis accounted for 81%, the mean gain in mouth opening was 29mm with no reported recurrence. Conclusion: using conservative gap arthroplasty in children is a success option within the justified inclusion criteria.

Lateral Arthroplasty as an Optimal Treatment for Surgical Management of Unilateral Temporomandibular Joint Ankylosis Type III in Children

Management of temporomandibular joint (TMJ) ankylosis described in the literature showed many surgical techniques. Purpose: The aim of this study was to evaluate the lateral TMJ arthroplasty as a surgical technique for treatment of type III Sawhney’s TMJ ankylosis in children both clinically and radiographically. In that surgical technique the need of a costochondral graft for reconstructive arthroplasty is avoided with its potential complications (as a donor site) and the unpredictable growth pattern. Materials & Methods: Eight children with unilateral type III Sawheny ankylosis (ankylosis on the lateral aspect of the medially displaced condyle) were included in this research. They all underwent lateral TMJ arthroplasty with the aid of panoramic and coronal C.T views. Evaluation was done both clinically and radiographically regarding interincisal distance, lateral TMJ movement, protrusive movements, postoperative pain, patient’s satisfaction and hazards of facial nerve injury. All patients were seen weekly for 4 weeks, at three and six months then at one year. Results: The used surgical technique of lateral arthroplasty had greatly achieved the desired goals of treating TMJ ankylosis during a follow up period of one year. Those achieved goals include restoration of full mandibular function and free movements of the joint with adequate mouth opening and a mean interincisal distance of 35 mm, maintaining acceptable occlusion and ramus height and obviates the need of any autogenous chondro-osseous graft (commonly costochondral) with potential complications of the donor sites. Conclusion: The surgical procedure of lateral arthroplasty is an easy and safe technique. It is considered as an effective treatment modality in treatment of type III TMJ ankylosis especially in children.

Comparison between gap arthroplasty and interpositional arthroplasty of temporomandibular joint ankylosis in children: a meta-analysis

Comparison between gap arthroplasty and interpositional arthroplasty of temporomandibular joint ankylosis in children: a meta-analysis

Ultrathin Silicon Sheet in the Management of Unilateral Post-traumatic Temporo-Mandibuar Joint Ankylosis in Children: A Good Alternative to Conventional Techniques.

We have described a new technique of using ultra-thin silicon sheet (0.2mm) between two transected bony ends for temporo-mandibular joint (TMJ) ankylosis in children with advantages of short operative time, minimal foreign material insertion and faster recovery time post-operatively which makes our technique a good alternative to conventional techniques. Our study is a non-randomized prospective study conducted on 10 children aged between 4 and 15years who presented to our tertiary care institute with severe trismus after traumatic injury and were willing to undergo this new technique. The main outcome measure taken into consideration was difference between pre-operative, intra-operative (on table) and post-operative mouth opening (minimum 2years follow-up). The pre-operative mouth opening in our cases varied from 1 to 5mm. The intra-operative mouth opening achieved ranged from 2.8 to 3.2cm. The mouth opening was about more than 2.7cm in all our cases at 2years of follow-up. Our technique is a good alternative to conventional techniques used for TMJ ankylosis in children but few more randomized controlled trials are required to assess its effectiveness in comparison to conventional techniques and for universal adoption of this technique.

Diagnosis of temporomandibular joint (TMJ) ankylosis in children

Temporomandibular joint (TMJ) ankylosis involves fusion of the mandibular condyle with the base of the skull. It results in functional, esthetic, and psychosocial limitations, if it affects children at an early age. Hence, it is important to recognize and diagnose the pathology and provide immediate treatment alternatives to improve the patient condition. In this case report, we highlight the diagnostic perspective of TMJ ankylosis in children, and the use of 3D computed tomography as an effective diagnostic aid.

Management of temporomandibular joint ankylosis in children with arthroplasty and distraction osteogenesis in the same surgical time

Temporomandibular joint (TMJ) ankylosis in children is a challenging problem for the maxillofacial surgeon since the surgical technique is difficult and the recurrence rate is high. It is characterized by a hipomobility, breathing, eating problems,and facial asymmetry. There is a vertical and sagittal mandibular deficiency. Numerous treatment approaches have been proposed in the literature. The surgical excision of the ankylotic mass is mandatory; gap arthroplasty and interpositional flaps have been discussed.

Efficacy of abdominal dermis fat graft as the interpositional material in the management of Temporomandibular joint ankylosis in children- an original study

Efficacy of abdominal dermis fat graft as the interpositional material in the management of Temporomandibular joint ankylosis in children- an original study

Pediatric TMJ Ankylosis: Treatment Using Vertical Sliding Osteotomy of the Mandibular Ramus

Temporomandibular joint (TMJ) ankylosis or hypomobility involves fusion of the mandibular condyle to the base of the skull. It is most frequently caused by trauma, presents with restriction in mouth opening in early stages and, in children, it may result in facial growth retardation. Various methods are available for surgical correction, such as autogenous grafts, gap arthroplasty, and prosthetic reconstruction. However, such techniques present several disadvantages and may lead to relapse, decrease in the vertical height of the posterior mandible and, in the case of prosthetic reconstruction, be contraindicated for the treatment of pediatric patients. The aim of this paper is to present a case of bilateral TMJ ankylosis in a 9-year-old patient treated by the technique of vertical sliding osteotomy, a simple surgical procedure indicated for the treatment of TMJ ankylosis in children, with the results after a 3-year follow-up.

Withdrawn: TMJ Ankylosis in Children: Comparison of 3 Methods of Joint Reconstruction

Statement of the Problem: Temporomandibular joint (TMJ) ankylosis is a challenging problem for children relative to function and growth. Different methods of treatment exist to manage this pathology but recurrence rate is high. This study evaluated the results of treating TMJ ankylosis in children using 3 different methods of TMJ reconstruction.

A Protocol for Management of Temporomandibular Joint Ankylosis in Children

Temporomandibular joint (TMJ) ankylosis in children is a challenging problem. Surgical correction is technically difficult and the incidence of recurrence after treatment is high. The purpose of the present report is to describe the protocol currently used at the Massachusetts General Hospital for the management of TMJ ankylosis in children. It has been our observation that the most common cause of treatment failure is inadequate resection of the ankylotic mass and failure to achieve adequate passive maximal opening in the operating room. The 7-step protocol consists of 1) aggressive excision of the fibrous and/or bony ankylotic mass, 2) coronoidectomy on the affected side, 3) coronoidectomy on the contralateral side, if steps 1 and 2 do not result in a maximal incisal opening greater than 35 mm or to the point of dislocation of the unaffected TMJ, 4) lining of the TMJ with a temporalis myofascial flap or the native disc, if it can be salvaged, 5) reconstruction of the ramus condyle unit with either distraction osteogenesis or costochondral graft and rigid fixation, and 6) early mobilization of the jaw. If distraction osteogenesis is used to reconstruct the ramus condyle unit, mobilization begins the day of the operation. In patients who undergo costochondral graft reconstruction, mobilization begins after 10 days of maxillomandibular fixation. Finally (step 7), all patients receive aggressive physiotherapy. A case series of children with ankylosis treated using this protocol is presented.

A Clinical Study on Temporomandibular Joint Ankylosis in Children

Temporomandibular joint (TMJ) ankylosis is a disabling condition of the masticatory system and is most commonly due to trauma, infections, and some systemic diseases. Hypomobility affects the surrounding structures as well as the joint itself. Ankylosis arising in early childhood usually leads to facial asymmetry. Ankylosis in children usually occurs from an intracapsular compression fracture or rarely from a suppurative arthritis of middle ear infection.Treatment of the ankylosis is probably one of the greatest challenges in TMJ surgery, and the treatment of TMJ ankylosis in children is much more challenging than in adults because of high recurrence and the probable change in the unpredictable growth of the mandible. In treatment of TMJ ankylosis in children, to maintain a normal growth and the development of the face is as important as to provide a satisfactory mouth opening with free movement of the mandible.A variety of techniques and various success rates in the treatment of TMJ ankylosis both in adults and in children have been reported. However, no single method has produced uniformly successful results. In this study, gap arthroplasty was applied in 6 patients, and 2 different types of fossa implants were used as interpositional material in the other 8 patients, and the results of the treatments have been evaluated retrospectively.

Surgical Management of Posttraumatic Temporomandibular Joint Ankylosis by Functional Restoration with Disk Repositioning in Children

Management of temporomandibular joint ankylosis poses a challenge because of technical difficulties and recurrence. The problem is more troublesome in children because of the involvement of postoperative development of the mandible. During the process of management of temporomandibular joint ankylosis, in many cases, the authors observed that the disk may exist outside of the bone mass in posttraumatic ankylosis. On the basis of this fact, the authors' working hypothesis was that if the disk could be retained and repositioned, with limited resection of the residual stump of the ramus to maintain its height, the structure and function of temporomandibular joint could be restored to a maximum degree to provide normal function and growth in children. Ten children with temporomandibular joint ankylosis underwent this approach, in which the disk was retained and repositioned and the residual stump of the ascending ramus was preserved and reshaped to maintain its height. All patients were reviewed regularly and evaluated retrospectively. The follow-up period ranged from 17 to 52 months (average, 32.9 months). All patients had significant improvement in mouth opening and showed a distinctive improvement both in articular functionality and in symptoms. No relapse occurred and no secondary deformity in the mandible resulted. The approach described not only helps to prevent relapse of temporomandibular joint ankylosis but also takes postoperative mandible development into consideration. The authors deem that it is a good choice for surgical management of posttraumatic temporomandibular joint ankylosis in children.

Re: Treatment of Temporomandibular Joint Ankylosis in Children: Is it Necessary to Perform Mandibular Distraction Simultaneously?

Re: Treatment of Temporomandibular Joint Ankylosis in Children: Is it Necessary to Perform Mandibular Distraction Simultaneously?

Temporomandibular joint reconstruction in children using costochondral grafts

Purpose: The aim of this study was to evaluate the postoperative growth of the mandible after reconstruction of the condylar process using costochondral grafts in children. Patients and Methods: Temporomandibular joint (TMJ) ankylosis was surgically treated and the joint reconstructed with a costochondral graft (CCG) in two boys and eight girls with a mean age of 7.4 years. Two children had bilateral ankylosis. Postoperative changes and craniofacial growth were monitored by lateral and posteroanterior (PA) cephalograms annually from 2 to 6 years (mean of 4 years). Results: Postoperatively, in the eight children with unilateral TMJ reconstruction, the mandible (Co-Gn) grew an average of 14.7 mm in length on the affected side and 15.1 mm on the nonaffected side; ramus length (Co-Go) increased an average of 7.1 mm on the affected side and 7.3 mm on the nonaffected side. However, in five of the children the chin progressively deviated toward the nonaffected side after TMJ reconstruction. The CCGs tended to have a more vertically directed condylar growth pattern and a more laterally positioned condyle. In the two cases with bilateral TMJ reconstruction, the CCGs grew until there was a mandibular prognathism that required orthognathic surgery to set back the mandible. Conclusions: Using CCGs to reconstruct TMJ ankylosis in children provides a functional condyle with growth potential. However, there is a possibility of excessive growth of the graft, resulting in deviation of the chin and mandibular prognathism years later.

Rehabilitating children with temporomandibular joint ankylosis

Although the probability of ankylosis following injury of the temporomandibular joint is small, patients, especially children with temporomandibular joint ankylosis, are greatly handicapped. Of the 42 cases of ankylosis seen in our clinic, six occurred in the adult, and 36 in children under 14 years of age. Treatment in all cases was surgical, and the results were beneficial, although the greatest difficulty in the treatment had been the early recurrence of ankylosis. Based on our experience, osteoarthrotomy for temporomandibular joint ankylosis in children has been advocated.

Surgical management of temporomandibular joint ankylosis in children

Surgical management of temporomandibular joint ankylosis in children