The interpositional dermis-fat graft in the management of temporomandibular joint ankylosis

The aim of this retrospective clinical study is to present the clinical experience of using dermis-fat interpositional grafts in the surgical management of temporomandibular joint (TMJ) ankylosis in adult patients. Eleven adult patients who presented with ankylosis of the TMJ were identified and included in the study. All patients underwent a TMJ gap arthroplasty which involved the removal of a segment of bone and fibrous tissue between the glenoid fossa and neck of the mandibular condyle. The resultant gap was filled with an autogenous dermis-fat graft procured from the patient's groin. All patients were followed up for a minimum of 2 years. Five of the 11 patients were found to have osseous ankylosis while 6 patients had fibro-osseous ankylosis. Two patients had bilateral TMJ ankylosis that were also treated with costochondral grafts which were overlaid with dermis-fat graft. The average interincisal opening was 15.6 mm on presentation which improved to an average of 35.7 mm following surgery. Patients were followed up from 2 to 6 years post-operatively (mean 41.5 months) with only 1 re-ankylosis identified out of the 13 joints treated. This study found that the use of the autogenous dermis-fat interpositional graft is an effective procedure for the prevention of re-ankylosis up to 6 years following the surgical release of TMJ ankylosis.     

Management of temporomandibular joint ankylosis with temporalis fascia flap and fat graft

AimTemporomandibular joint (TMJ) ankylosis is a serious problem that restricts jaw mobility and causes disturbances in facial and mandibular growth. The purpose of this paper is to present an easy and versatile method for the treatment of TMJ ankylosis to decrease postoperative complications such as re-ankylosis.Material and methodEleven patients who presented with ankylosis of the TMJ underwent surgical release. After performing gap arthroplasty through a preauricular approach, the temporalis fascia flap was transposed to the gap. An autogenous fat graft was then obtained from the abdomen and used as interpositional material. The follow-up time was 3–5 years.ResultsRe-ankylosis did not occur in any of the patients, and all had satisfactory mouth opening.ConclusionSurgical treatment of TMJ ankylosis with gap arthroplasty, interposition of the temporalis fascia flap and fat grafting is an effective and easily procedure for preventing of re-ankylosis. The autogenous nature and close proximity to the joint are the main advantages of the temporalis fascia flap when compared with other interpositional materials, and the fat graft provides additional support by reducing pressure.     

Auricular cartilage graft interposition after temporomandibular joint ankylosis surgery in children.

PURPOSE: After surgery for temporomandibular joint (TMJ) ankylosis, relapse is frequently due to fibrosis and ossification occurring in the space of the joint. The object of this study was to evaluate the use of autogenous auricular cartilage graft as an interposition material after arthroplasty of the TMJ ankylosis. PATIENTS AND METHODS: Seven patients with TMJ ankylosis were treated with autologous auricular cartilage graft interposition arthroplasty. With 4 to 6 years of follow-up, the function of the TMJ was evaluated. RESULTS: In 7 patients with TMJ ankylosis treated with autologous auricular cartilage graft interposition arthroplasty, the function of the TMJ recovered well. At 6-year follow-up, no relapse had occurred and no deformities resulted in the ear from which the cartilage had been harvested. CONCLUSION: Autologous auricular cartilage interposition arthroplasty is an ideal method for the prevention of relapse of TMJ ankylosis.     

Treatment of temporomandibular joint ankylosis with temporalis muscle and fascia flap.

This study sought to determine the efficacy of interpositional arthroplasty with temporalis muscle and fascia flap in the treatment of unilateral temporomandibular joint (TMJ) ankylosis in adults. This retrospective study of seven cases evaluated the postoperative results of interpositional arthroplasty on temporalis muscle and fascia flap in adults. The operative protocol for unilateral TMJ ankylosis entailed, (1) resection of ankylotic mass, (2) intraoral ipsilateral coronoidectomy, (3) contralateral coronoidectomy when necessary, (4) interpositional tissue transfer to the TMJ with temporalis muscle and fascia flap, (5) maxillomandibular fixation (MMF), and (6) early mobilization and aggressive physiotherapy. The results of this protocol were encouraging, while the functional results of interpositional arthroplasty on temporalis muscle and fascia flap were satisfactory. The findings of this study support the use of temporalis muscle and fascia flap in adult patients with unilateral TMJ ankylosis. Early postoperative initial exercise, physiotherapy, and strict follow-up play an important role in preventing postoperative adhesions.     

颞肌筋膜瓣联合冠突移植治疗颞下颌关节强直

目的:应用带蒂颞肌筋膜瓣联合冠突移植治疗颞下颌关节真性强直,评价其重建颞下颌关节的效果。方法:对6例颞下颌关节真性强直患者切除病变区骨质,形成骨间隙,采用带蒂颞肌筋膜瓣转移充填骨间隙和冠突切取植入构造新的“髁突”,重建颞下颌关节。手术后常规随访,评价其疗效。结果:全部病例术后随访4～28个月,开口度3.1～3.8cm,平均开口度3.5cm,效果满意。结论:带蒂颞肌筋膜瓣联合冠突移植治疗颞下颌关节真性强直具有多方面优势,是防止颞下颌关节术后复发的有效手术治疗方法。     

Suture of temporalis fascia and muscle flaps in temporomandibular joint surgery

This technical note illustrates a simple and effective technique of suturing the interpositional temporalis fascia and muscle flaps in temporomandibular joint surgery.     

Full-thickness skin graft interposition after temporomandibular joint ankylosis surgery. A study of 31 cases.

Recurrence is a major problem after release of temporomandibular joint ankylosis. Early physiotherapy and choice of interpositional material are important in preventing recurrence. Currently, the most used technique is gap arthroplasty associated with coronoidectomy, temporalis muscle flap interposition and reconstruction of the condylar unit with a costochondral graft. Full-thickness skin graft interposition, using the technique described by Popescu & Vasiliu, can also be used. This retrospective review of 31 patients confirms the reliability of full-thickness skin graft interposition. Results were successful in 90% of the 20 patients with follow-up longer than one year.     

Simultaneous genial distraction and interposition arthroplasty for management of sleep apnoea associated with temporomandibular joint ankylosis

Temporomandibular joint (TMJ) ankylosis affects the growth of the mandible and results in gross facial deformities. A critical clinical feature of long-standing TMJ ankylosis is retrogenia, which when combined with an inability to open the mouth leads to severe compromise of the airway. A case is presented of obstructive sleep apnoea syndrome secondary to TMJ ankylosis that was corrected by a new technique employing simultaneous genial distraction along with interposition arthroplasty.     

The use of temporalis muscle graft,fresh and cryopreserved amniotic membrane in preventing temporomandibular joint ankylosis after discectomy in rabbits

PurposeThe aim of the study was to evaluate the efficacy of temporalis muscle-fascia graft, fresh and cryopreserved human amniotic membrane as an interpositional material in preventing temporomandibular joint ankylosis in a rabbit model.Materials and methodsIn this experimental study, 21 New Zealand white rabbits were used. The condyle and the joint disc were removed to induce ankylosis in left TMJs. Reconstruction was immediately performed with temporalis muscle-fascia graft (tMFG) in group I (n = 7), fresh human amniotic membrane (fHAM) in group II (n = 7) and cryopreserved human amniotic membrane (cHAM) in group III (n = 7). All rabbits were sacrificed at 3 months after the operation. The comparison was made among three groups by means of vertical mouth opening and weight measurements, radiologic and histologic findings obtained before and after surgery.ResultsIn all rabbits, there was no statistically significant difference in the jaw movements and weight among groups at commencement and 3 months after surgery. The condylar surfaces were more irregular in HAM groups. There were mild osteophyte formations, sclerosis, fibrosis and calcification around the condyle in all groups however the joint gap was more preserved in group I. All interpositional materials were also seen to be partially present in the joint gap at 3 months. Ankylosis was not seen in the joint gap in any group.ConclusionWith the results of this study it was concluded that interpositional arthroplasty with HAM and tMFG have an almost similar effect in preventing TMJ ankylosis after discectomy in the rabbit model.     

The role of a temporalis fascia and muscle flap in temporomandibular joint surgery

Temporalis fascia, with a varying thickness of temporalis muscle, may be harvested as an axial flap based on the middle and deep temporal arteries and veins. The dependable blood supply, the proximity to the temporomandibular joint, and the ability to alter the arc of rotation by basing the flap inferiorly or posteriorly make this a versatile flap for lining the temporomandibular joint. In this report, the anatomy is reviewed, the harvesting technique is described, and multiple uses of the temporalis muscle-fascia flap in temporomandibular joint surgery are described.     

小儿颞下颌关节强直手术的麻醉处理

目的: 探讨小儿颞下颌关节强直手术的麻醉和困难气道管理。方法: 回顾性分析43例小儿颞下颌关节强直开口受限,困难气道病例资料,在保留自主呼吸的情况下,分为氯胺酮组（K1组）和氯胺酮复合右美托咪定组（K2组）。K1组和K2组均静脉给予氯胺酮1~2 mg/kg,K2组则追加静注右美托咪定1 μg/kg。患者意识消失后,辅以气管内和咽喉区表面麻醉。采用纤维支气管镜经鼻腔气管插管。插管过程中,根据患者反应小剂量滴定氯胺酮,维持麻醉深度。采用GraphPad Prism 6.0软件对数据进行统计学分析。结果: 所有患儿均在纤维支气管镜下经鼻腔成功气管插管。插管过程中,氧饱和度<95%发生率K2组略低于K1组,差异无统计学意义（P>0.05）。插管过程中追加氯胺酮次数和氯胺酮总剂量K2组显著低于K1组（P<0.05）,插管时心率变化和插管用时K2组显著低于K1组（P<0.05）。结论: 氯胺酮麻醉辅以良好的气管内和咽喉区表面麻醉,可完成小儿颞下颌关节强直开口受限的困难气道纤维支气管镜插管,氯胺酮复合右美托咪定可使小儿困难气道的插管过程更短、更平稳。     

Retrospective comparison of autogenous cosotochondral graft and coronoid process graft in the management of unilateral ankylosis of the temporomandibular joint in adults

We retrospectively compared the clinical outcomes of autogenous coronoid process grafts (n = 32) and costochondral grafts (n = 28) in condylar reconstruction for the treatment of unilateral ankylosis of the temporomandibular joint (TMJ) in adults. Preoperative and postoperative assessments included diet scores, cone-beam computed tomography (CT), maximal interincisal opening, lateral excursion, and mandibular deviation on opening the mouth. There were no significant differences between the 2 groups in the measurements before and after the operation with respect to incisal opening, lateral excursion, mandibular deviation, diet scores, or recurrence rate, but in both the postoperative incisal opening, lateral excursion, and diet scores had improved significantly compared with preoperatively. After costochondral graft 3 patients developed intraoperative plural tears, and 6 had temporary pain at the donor site. The frontal branch of the facial nerve was temporarily affected in 5 patients after costochondral graft and 3 after coronoid process grafts, all of which recovered in 3–6 months. There was no recurrence after coronoid process grafting, and one after costochondral grafting. The clinical outcomes in both groups were satisfactory and comparable. Autogenous coronoid process grafting may therefore be a good alternative for condylar reconstruction in patients with ankylosis of the TMJ.     

Treatment of temporomandibular joint ankylosis: gap and interpositional arthroplasty with temporalis muscle flap

Purpose

The purpose of this study was to examine the effectiveness of gap and interpositional arthroplasty with temporalis muscle flap in the treatment of the temporomandibular joint (TMJ) ankylosis.

Materials and methods

This retrospective study was evaluated on 34 patients who were treated from February 2003 to July 2007. Diagnosis of TMJ ankylosis was based upon the clinical examination and plain radiography and CT scan. Eight patients (23.5%) had bilateral TMJ ankylosis, and four patients had reankylosis (that had been operated in another center). Trauma was the most etiological factor (88.2%) and osteochondroma of the condyle in one patient caused ankylosis.

Results

Means of maximum mouth opening before and after operation were 5.00 (SD) 3.45 mm and 32.85 (SD) 5.51 mm, respectively. Reankylosis in two patients (5.9%) and facial nerve dysfunction in 12 surgery sides (28.5%) were noted.

Conclusion

The findings of this study suggest that the gap arthroplasty with temporalis muscle flap as interpositional graft is an effective method in the treatment of TMJ ankylosis. The osteoarthrectomy of the callus to create at least 10 mm gap and enough bulk of temporalis muscle flap as interpositional graft followed by at least a 6-month physiotherapy which play an important role in prevention of reankylosis.     

Report of ankylosis of the temporomandibular joint: treatment with a temporalis muscle flap and augmentation genioplasty

A case of true bilateral ankylosis of the temporomandibular joint (TMJ) is presented. A 19-year-old male patient had a life-threatening ear infection at the age of ten resulting in a progressive restriction of his mouth opening. He presented with almost complete lack of mobility of the mandible. Surgical treatment was a resection of the ankylotic mass, interpositional temporalis composite muscle flaps, and early mobilization and aggressive physiotherapy. The functional results of the interpositional arthroplasty were excellent. After a two-year follow up, an augmentation genioplasty was performed in order to improve facial aesthetics.