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Gap arthroplasty of temporomandibular joint ankylosis by transoral access: a case series
Affiliation:1. Department of Oral and Maxillofacial Surgery, Lanzhou General Hospital of PLA, Lanzhou, China;2. First Department of Medical Technology, Lanzhou General Hospital of PLA, Lanzhou, China;1. The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory for Oral Biomedical Engineering of the Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China;2. Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, China;1. Frenchay Hospital, Bristol, UK;2. Medical Regiment, Catterick, North Yorkshire, UK;3. Department of Surgery, The Royal London Hospital, Whitechapel, London, UK;4. Maxillo-Facial Surgery, Guy''s and St Thomas’ Hospital, London, UK;1. Division of Oral and Maxillofacial Surgery, Section of Orofacial Diagnostics and Surgery, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden;2. Department of Oral and Maxillofacial Surgery, Karolinska University Hospital, Huddinge, Sweden;3. Division of Image and Functional Odontology, Section of Orofacial Diagnostics and Surgery, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden;1. Assistant Professor, Department of Oral and Maxillofacial Surgery, Dental College and Hospital, Taibah University, Al-Madinah Al-Munawwarah, Saudi Arabia; and Associate Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Al-Azhar University (Girls Branch), Cairo, Egypt;2. Clinical Associate Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Al-Azhar University, Cairo, Egypt;3. Lecturer, Department of Anaesthesia and Intensive Care, Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt
Abstract:This article describes a technique of gap arthroplasty in temporomandibular joint (TMJ) ankylosis performed by transoral access. The treatment of TMJ ankylosis by creating an adequate gap is of paramount importance in preventing any future recurrence and this can be achieved only when good access is gained to this complex anatomical joint. Five patients with TMJ ankylosis (eight TMJ) were treated by gap arthroplasty using an intraoral approach. The average mouth opening before surgery was 8.6 mm and the average mouth opening achieved postsurgery was 37.9 mm. The average follow-up time was 13 months and none of the patients had any recurrence or significant complications during or after surgery. Our technique relies on the use of a stable landmark to trace the superior-most extent of the ankylotic mass thereby facilitating the removal of the entire mass including the medial extent. We found that even though transoral access is technically challenging and took an average time of 84 min, it has many advantages over conventional extraoral approaches in terms of facial scars and facial nerve injury. The authors also emphasize the importance of good postoperative physiotherapy and presurgical patient counselling to prevent future recurrences.
Keywords:gap arthroplasty  transoral access  temporomandibular joint ankylosis
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