Treatment Of Temporomandibular Joint Ankylosis Research Articles

Surgical Treatment of Temporomandibular Joint Ankylosis: our experience with 36 cases.

To evaluate and compare outcomes of patients with temporomandibular joint ankylosis (TMJA) treated by gap arthroplasty, costochondral graft, and total alloplastic joint reconstruction. A retrospective cohort study reviewed and analyzed data from patients with TMJA from January 1, 2009 to December 31, 2019, at the Maxillofacial and Oral Surgery Department, University of the Witwatersrand. Patients with TMJA were treated either with gap arthroplasty, costochondral graft, or total alloplastic joint reconstruction. Data collected included age, sex, etiology of ankylosis, sides involved, preoperation and postoperation mouth opening (MO), treatment type, complications, and revision surgery. Patients were followed up for at least 18 months after the surgical procedure. Comparison of means across the treatment groups was analyzed using paired t tests or analysis of variance test. A P value of less than 0.05 was considered statistically significant. The study sample comprised of 36 patients [bilateral, n=22; unilateral, n=14 (21 male, 15 female)]. Trauma was the most common etiology (n=27, 75%), followed by chronic infections (n=4, 11.11%) and juvenile arthritis (n=3, 8.3%). A paired t test revealed no statistical significance between treatment modality and postoperative MO and complications over 18 months (P=0.5316 and P=0.426, respectively). The mean MO increased from 4 to 28mm. Reankylosis was the most common complication (n=5). All 3 treatment options yield acceptable outcomes in patients with TMJA. Irrespective of surgical technique, early postoperative exercises, active physiotherapy, and follow-up are imperative for successful rehabilitation and prevention of reankylosis.

Treatment of temporomandibular joint ankylosis with total prosthetic joint reconstruction: a case series and scoping review of the literature

Treatment of temporomandibular joint ankylosis with total prosthetic joint reconstruction: a case series and scoping review of the literature

Effectiveness of Dermis Fat Graft Versus Temporalis Myofascial Flap for Interposition in Temporomandibular Joint Ankylosis: A Systematic Review.

Temporomandibular joint ankylosis is a disabling condition which affects joint movements causing difficulty in speech, mastication and hygiene. Over time various interposition materials like meniscus, muscle, fascia, skin, cartilage, fat, dura and alloplastic materials have been used for the treatment of ankylosis and improve joint functions. The objective of this systematic review is to evaluate the effectiveness of dermis fat graft and temporalis myofascial flap as an interpositional material in treatment of temporomandibular joint ankylosis and to compare the effectiveness of the two materials. PubMed, Google scholar, and Cochrane library search in combination with hand search of relevant journals were conducted published in English from January 2000 to August 2021. Randomized controlled trials, prospective and retrospective cohort studies were included. Outcome measure included improvement in mouth opening. Risk of bias assessment was assessed using Cochrane risk of bias tool and Newcastle-Ottawa scale. A total of 144 articles were found from the primary search which on thorough assessment, duplicate and exclusion removal resulted in 9 cohort studies and 1 randomized controlled trial that fulfilled the inclusion criteria. All the studies included reported significant improvement in mouth opening after interposition of the 2 materials. Four studies compared temporalis myofascial flap with dermis fat graft, 2 studies reported dermis fat graft gives better outcomes, whereas 1 study reported temporalis myofascial flap to be better and 1 study has been inconclusive. Definitive conclusions cannot be drawn as there are number of limitations in the studies included. However a general consensus has been toward dermis fat graft owing to fewer complications. The online version contains supplementary material available at 10.1007/s12663-023-01869-9.

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.

Perioperative trigeminocardiac reflex in patients undergoing surgical treatment of temporomandibular joint ankylosis: A study.

Purpose:The behavior of trigeminocardiac reflex (TCR) is limited to few case reports only in maxillofacial surgery, especially for temporomandibular joint (TMJ) ankylosis cases. The present study aims to find out the incidence of bradycardia due to TCR during intraoperative forceful mouth opening in TMJ ankylosis patients.Materials and Methods:A prospective, unicentric observational study was conducted selecting those patients who were planned for osteoarthrectomy with interpositional gap arthroplasty under general anesthesia. Sixty cases of TMJ ankylosis were randomly selected from December 2018 to-03-2020. Predictor variables were patient age, gender, and type of ankylosis, and outcome variables were pulse rate, mean arterial blood pressure (MABP), and oxygen saturation level (SPO2). Data were recorded at baseline and during intraoperative mouth opening via heister jaw stretcher. A Chi-square test was used for testing the association between variables. P values were considered statistically significant at <0.05.Results:The sample size of 60 subjects has been divided into two age groups (10–19) years and (20–40) years. The mean standard deviation age of the patients was 18.32 ± 6.81 years. About 63.3% were male. Out of 60 cases, 14 patients developed bradycardia. The frequency of bradycardia was found 23.3%. According to logistic regression analysis, age and type of ankylosis were the significant predictors of bradycardia.Conclusion:We conclude that bradycardia due to TCR in TMJ ankylosis patients is not an uncommon entity. Incidences are more prevalent in the age group of 10–19 years and type IV bony ankylosis. Male had a high incidence of bradycardia though P value was nonsignificant.

Autogenous Grafts for Condylar Reconstruction in the Treatment of Temporomandibular Joint Ankylosis

Background: Temporomandibular joint (TMJ) ankylosis is distinguished by complexity or failure to open the mouth, leading to facial asymmetry, and malaligned teeth due to fusion of temporal bone with mandibular condyle. Objective: The present review aimed to discuss the different options of condylar reconstruction in TMJ ankylosis patients by autogenous grafts as reported in previous studies. Materials and Methods: A wide-ranging electronic search was performed by the following electronic databases: PubMed (Central), Hinari, and Google Scholar. A total of 25 full-text articles were found to meet the inclusion criteria and were reviewed for qualitative analysis in this study. Results: Surgery with or without condylar reconstruction is the only treatment alternative for TMJ ankylosis patients. Removal of ankylotic mass followed by condylar reconstruction with different existing autogenous grafts such as costochondral (CCG), sternoclavicular (SCG), coronoid, and metatarsal are done by surgeons. However, the costochondral graft is a preference by most surgeons due to its easy accessibility and adaptation. Distraction osteogenesis (DO) provides fewer complications with excellent efficient results in TMJ reconstruction. Conclusions: Up till now, any of the autogenous grafts for condylar reconstruction are not ideal for rebuilding the TMJ complex anatomy. CCG is still now the main choice for surgeons to reconstruct the TMJ in pediatric patients. DO has become popular recently.

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.

Challenges during bilateral total temporomandibular joint replacement for ankylosis in ankylosing spondylitis patient-a case report

Alloplastic replacement of temporomandibular joint is the preferred treatment for temporomandibular joint ankylosis (TMJA) in ankylosing spondylitis (AS) patients. These patients exhibit neck rigidity due to fixed flexion deformity or fusion of vertebrae that make the intubation and surgical positioning of patients difficult and challenging. Chin on the chest makes tracheostomy almost impossible. Fiberoptic-assisted intubation is recommended. It is mandatory that no neck flexion or rotation is performed during intubation or surgical positioning. The use of an operating table that permits lateral tilt is recommended for surgical positioning. 15-20-degrees tilt of table or a lateral positioning of the patient, can provide sufficient neck support and reduce the chances of lateral neck rotation or neck flexion. Improper positioning may result in readjusting the patient's neck repeatedly during operative procedure. This may cause serious neurological injury. Minimal documentation exists for proper and secure positioning of the patient for bilateral alloplastic joint replacement in AS patients. The authors present a case of bilateral TMJA in AS patient who was managed successfully by awake fiberoptic intubation and lateral positioning for alloplastic total joint replacement (TJR).

Temporomandibular Joint Ankylosis Surgery in Children

A variety of techniques have been described in the literature for the treatment of temporomandibular joint ankylosis. However, 1 of the factors most commonly related to the failure of maintenance mouth opening in the postoperative period is the inadequate excision of the ankylotic mass. Furthermore, the surrounding noble structures, such as the base of the skull, internal maxillary artery, and dental germs, are at risk of being affected during the procedure. For this reason, prototyped guides have been proposed to steer osteotomies and resections of the ankylotic block in the temporomandibular joint. Nevertheless, access to this technology, especially in developing countries, can represent a financial barrier. Therefore, our proposal is to manufacture low-cost surgical cutting guides to increase their applicability.

COMBINED TEMPOROPARIETAL FASCIA AND THIN SILICON SHEET AS INTERPOSTIONAL ARTHROPLASTY FOR THE MANAGEMENT OF TMJ ANKYLOSIS- AN EXPERIENCE BASED ON SINGLE INSTITUTIONAL STUDY

Introduction: Temporomandibular joint ankylosis is a debilitating condition leading to problems in mastication, speech, digestion, oral hygiene and even facial appearance. The basic techniques for surgical correction of ankylosis include the gap arthroplasty, joint reconstruction or interpositional arthroplasty. The treatment of TMJ ankylosis poses a significant challenge because of technical difficulties and a high incidence of recurrence.&#x0D; Material and Methods: 21 patients of temporomandibular joint ankylosis admitted from 2015 to 2018 in the Department of Plastic Surgery, SMS Hospital, Jaipur. . Diagnosis was based on history and clinical assessment supplemented with orthopantomogram (OPG) and computer tomographic scans. Mouth opening is measured as interincisoral distance using a scale. Intraoperatively, silicon sheet is sutured with the distal part of flap using non absorbable suture in half overlapped fashion with an overlapped portion across the joint space. Preoperative photograph is taken in all patients and serial post operative photograph were taken during their regular follow up&#x0D; Results: 21 patients were part of the study (14 males and 7 females). 16 of our patients were post traumatic. Their age ranged from 7 to 55 years. The disease was unilateral in 19 cases and bilateral in 2 cases. The pre-op interincisal mouth opening ranged from 0 to 9 mm. The intra-operative interincisal mouth opening ranged from 28 to 46 mm. There was no immediate complication and no incidence of facial nerve injury. One patient with bilateral congenital TMJ ankylosis had recurrence. Five patients were lost after the initial 1-year follow-up. &#x0D; Conclusion: Use of combined temporoparietal fascia with thin silicon sheet as interpositional arthroplasty provides extra protection in cases of TMJ ankylosis and thereby decreasing the incidence of its recurrence &#x0D; Keyword: Ankylosis, TMJ, Interpositional 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.

Evaluating the remodeling of condyles reconstructed by transport distraction osteogenesis in the treatment of temporomandibular joint ankylosis

PurposeThis study aimed to evaluate the remodeling of condyles reconstructed by transport distraction osteogenesis (DO) in patients with temporomandibular joint (TMJ) ankylosis. Patients and methodsTwenty-one patients with 26 affected joints were followed up for 34.1 ± 13.3 months. Patients who had undergone gap arthroplasty and TMJ reconstruction by DO were included. Maximal mouth opening (MMO) and occlusion were recorded. Computed tomography images were obtained preoperatively (T0), upon completing distraction (T1), upon removal of the distraction device (T2), and >2 years postoperatively (T3). The following were measured: mandibular ramus height, distance between gonion and Frankfurt plane (Go–FN), condylar width, and condyle–ramus angulation. ResultsOf the 21 patients, one showed re-ankylosis, while five exhibited anterior open bite. From T1 to T3, the total amount of resorption of ramus height reached up to 8.2 ± 4.6 mm (p < 0.001), in comparison with a total distraction length of 13.8 ± 4.1 mm; the mean resorption rate was 59.4%. Similarly, Go–FN decreased by 6.2 ± 4.0 mm (p < 0.001). ConclusionOur findings indicated that DO combined with gap arthroplasty was an effective method for the treatment of TMJ ankylosis to improve MMO. The reconstructed condyle exhibited a high frequency of resorption in height.

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.

Accuracy of virtual surgical planning in treatment of temporomandibular joint ankylosis using distraction osteogenesis: comparison of planned and actual results

Accuracy of virtual surgical planning in treatment of temporomandibular joint ankylosis using distraction osteogenesis: comparison of planned and actual results

Treatment of temporomandibular joint ankylosis with customized prosthesis: case report

Treatment of temporomandibular joint ankylosis with customized prosthesis: case report

Treatment of tmj ankylosis with alloplastic reconstruction associated with virtually planned orthognathic surgery: case report

Background: Temporomandibular joint (TMJ) ankylosis refers to adhesion between the mandibular condyle and the glenoid fossa, maxilla, zygoma or skull base. Such adhesion may be fibrous or bone. TMJ ankylosis is usually associated with trauma, systemic infection or systemic diseases such as ankylosing spondylitis, rheumatoid arthritis and psoriasis. Total alloplastic reconstruction of TMJ is an option for patients with important limitations, dysfunctions or pathological changes.

Gap arthroplasty with active mouth opening exercises using an interocclusal splint in temporomandibular joint ankylosis patients

BackgroundTemporomandibular joint (TMJ) ankylosis during early childhood may lead to disturbances in growth and facial asymmetry and to serious difficulties in eating as well as in breathing during sleep. The purpose of this study is to describe the effectiveness of an interocclusal splint (IOS) for active mouth opening exercises in the treatment of TMJ ankylosis.MethodsA total of nine patients with 13 instances of TMJ ankylosis from 2008 to 2010 were included in this study, of which five patients were male and four patients were female. Five patients demonstrated unilateral ankylosis, while five patients showed bilateral symptoms. Ankylosed mass resection with coronoidectomy, fibrotic scar release, and resection of stylohyoid ligament calcification was performed with gap arthroplasty without an interpositional graft, and all patients were assessed for maximum mouth opening (MMO) during a mean 6.6-year follow-up period.ResultsAll patients were subjected to postoperative mouth opening exercises from the day of the operation with the help of an IOS, which was based on an impression taken during surgery. All patients were sufficiently comfortable moving their mandible according to the IOS’s guiding plane and impingement, and satisfactory results were achieved, in which MMO was improved by 35 mm more than 6 years after surgery.ConclusionsComplete and adequate resection of the ankylosed mass and postoperative active mouth opening exercises are essential in the treatment of TMJ ankylosis. Moreover, a more comfortable mouth opening guide and interdigitation can be achieved using an IOS, and newly organized fibrosis in the gap space between the newly made resected condylar head and temporal fossa can be suggested.

Comparison of Temporalis Myofascial Flap vs Dermal Graft as an Interpositional Material in Treatment of Temporomandibular Joint Ankylosis: A Case Series

Comparison of Temporalis Myofascial Flap vs Dermal Graft as an Interpositional Material in Treatment of Temporomandibular Joint Ankylosis: A Case Series

Condyle-preserved arthroplasty versus costochondral grafting in paediatric temporomandibular joint ankylosis: a retrospective investigation

We aimed to evaluate results of condyle-preserved arthroplasty and costochondral grafting in growing children with temporomandibular joint ankylosis through medium-term follow-up and three-dimensional metric analysis. We assessed 11 patients (14 sides) with type II ankylosis (group A) and 11 patients (13 sides) with type III/IV (group B) from January 2012 to December 2015. Group A patients received condyle-preserved arthroplasty and group B patients received costochondral grafting. Postoperative computed tomography was used to measure condylar height, condylar width, mandibular ramus height and mandibular body length. Changes in maximum mouth opening were evaluated >1year postoperatively.Postoperative follow-up showed similar average maximum mouth opening and one case of recurrence in each group. Computed tomography measurements showed that condylar width and mandibular ramus height increased in both groups A and B (P<0.05). Moreover, in group A, condylar angulation of medially displaced malformation decreased by 13.2° (P<0.05), and mandibular body length increased by 5.7mm (P<0.05). Thus, both condyle-preserved arthroplasty and costochondral grafting were effective surgical methods for treatment of temporomandibular joint ankylosis. Moreover, compared with group B, group A patients manifested more remarkable mandibular growth, at least in the anteroposterior direction of the mandibular body.