Temporomandibular joint ankylosis

The reconstruction of a permanent functional joint and the provision for correction of any associated deformity are the aims of treatment of temporomandibular joint ankylosis. Methods which merely free the ankylosis, in our opinion, compromise the likelihood of achieving these aims.     

Temporomandibular joint ankylosis: review of thirty-two cases.

I have reviewed aetiology, sex, age at time of treatment, clinical features, radiographic findings, anaesthetic techniques, surgical treatment, complications, and results in 32 patients with ankylosis of the temporomandibular joint. Trauma and infection were the commonest causes of ankylosis: 50% and 41%, (n = 13), respectively. The 21-30 year age group had the most trauma cases. Twenty (63%) of the patients presented with bilateral ankylosis. Failing to do jaw-opening exercises was the main cause of relapse.     

Temporomandibular joint ankylosis: a case report

This report is based on a case of temporomandibular joint ankylosis discovered in a cadaver during routine student dissection in the Department of Anatomy at Tokyo Dental College. Extensive osseous ankylosis in the left temporomandibular joint was evident in this case which exhibited a distinctive bird-like facial deformity caused by a mandibular growth disorder. This resulted in the underdevelopment of the mental area in particular. Furthermore, abnormally enlarged antegonal notching was present along the inferior border of the mandible anterior to the angle. Both these manifestations indicated the likelihood that the ankylosis had contributed to the abnormalities and had commenced at an early stage of skeletal development.     

Temporomandibular joint ankylosis: report of 14 cases

The authors present a review of 14 patients with temporomandibular joint ankylosis treated between March 1992 and February 1997. Etiology of the ankylosis was trauma in four patients, ear infection in two, systemic infection in one case, congenital in another, and unknown in six. Patients were divided into two groups, according to their age: 16 years and under and over 16 years of age. The basic principle of surgical treatment in both groups is ample access for osseous resection and coronoidectomy. Costochondral grafts were used in group one (nine patients), while interposition of a silicone block, was performed in the second group (five patients). Follow-up evaluations were from twelve to 53 months (average 28.2 months). One case of recurrence occurred in the first group and no recurrences in the second group. The average long-term mouth opening in both groups was 32.8 mm.     

Temporomandibular joint ankylosis: surgical treatment and long-term results

The surgical treatment of 26 patients with ankylosis of the temporomandibular joint, as well as various methods and materials used for functional restoration are described. The significance of radical removal of the ankylotic bone, as well as the advantages of the interpositioning of the lyophilized cartilage, are emphasized.     

Temporomandibular joint ankylosis: a review of 44 cases

Introduction

Mandibular hypomobility may arise due to a wide variety of intraarticular as well as extraarticular disorders in the temporomandibular joint region. Temporomandibular joint ankylosis causes a variable restriction in jaw mobility. This study presents a broad overview of the management of temporomandibular joint ankylosis at the Department of Oral and Maxillofacial Surgery, GGSM Subharti Dental College, Meerut, Uttar Pradesh, India.

Materials and methods

Between May 2002 and September 2005, a total of 44 patients underwent surgical release of temporomandibular joint ankylosis. This study is a retrospective analysis of the patient population characteristics and the surgical procedures employed.

Results and discussion

The patients have completed a follow-up of 24 to 64 months (median, 38.5 months). Of the 44 patients, 12 had bilateral involvement. Trauma in childhood was, expectedly, the most frequent etiologic factor. Gap arthroplasty was the most frequently employed technique, followed by the use of autologous tissue interposition. The temporalis muscle-fascia and the temporalis fascia alone, as well as the auricular cartilage, were employed most frequently. Complete alloplastic condylar replacement was performed in one patient, who, unfortunately, returned with pain, clicking, and deviation of the jaw, necessitating removal within 1 month. Total joint replacement was abandoned after this case. We outline our protocol for the management of this disabling condition.     

Temporomandibular joint ankylosis surgery in a child: case report

Temporomandibular joint ankylosis is one of the most significant disorders of the stomatognathic system because it causes pain associated with severe functional limitations, such as difficulty in chewing and psychological and clinical problems due to poor oral hygiene. These disorders are quite significant in children, since the treatment is even more complex due to the fact that the condylar region is a site of active growth. The earlier the diagnosis is established, the better the treatment prognosis. Ankylosis can be treated by interposition arthroplasty of the temporalis muscle fascia in conjunction with ipsilateral coronoidectomy. The purpose of the present study was to report a clinical case of temporomandibular joint ankylosis in a pediatric patient treated by interposition arthroplasty of the temporalis muscle fascia associated with coronoidectomy.     

Dissertations 25 years after the date 7. Temporomandibular joint ankylosis

Ankylosis of the temporomandibular joint and the possibly associated deformation of maxillofacial bones are functionally and aesthetically serious problems. Despite the developments in oral and maxillofacial surgery, treatment of patients with ankylosis of the temporomandibular joint still remains challenging. This article presents a review of the developments in this treatment, 25 years after the publication of the thesis 'Temporomandibular joint ankylosis'. Nowadays, computer-tomography is the standard for imaging assessment, possibly combined with stereolithography. Resection of the ankylotic mass is the surgery method of choice. The gap is filled by interpositional tissue transfer of temporalis muscle or a fascia flap. Early mobilisation and intensive physiotherapy are needed. In case of maxillofacial asymmetry, distraction osteogenesis has proved to be successful.     

Temporomandibular joint morphology following post-traumatic ankylosis in 26 patients

This study evaluated the joint morphology on coronal computed tomography of ankylosed temporomandibular joints in 26 patients. All patients developed ankylosis following blunt trauma. Post-ankylosis joint morphology was assessed to determine if the precursor condylar fracture could be identified and this was compared to the condylar fracture prevalence to determine if any condylar fractures have an increased risk factor for ankylosis. Mean age at presentation was 20.9+/-14.41 years (range 6-58) and mean age at injury was 13.84+/-13.81 years (range 3-53). Thirty-seven joints were ankylosed in 26 patients (11 bilateral, 15 unilateral) with 27 joints in 19 patients showing vestiges of a medially dislocated condylar fracture (72.9% of joints). The prevalence of MDCF at our unit over a period of 6 months was 16.8% (16 of 95 condylar fractures). This suggests that a medially dislocated condylar fracture is more likely to ankylose than other condylar fractures. A hypothesis is proposed to explain this increased risk.     

Temporomandibular joint fibrous ankylosis following orthognathic surgery: report of eight cases

Undue pressure on the temporomandibular joint consequent to orthognathic surgery may result in fibrous ankylosis in the joint. Occurrence of this disorder may increase with the use of rigid internal fixation combined with 6 to 8 weeks of maxillomandibular fixation. Proper intraoperative placement of the proximal mandibular segment is the key to prevention of this complication, especially in high-risk joints.     

Surgical induction of temporomandibular joint ankylosis: an animal model.

PURPOSE: The aim of this study was to develop an animal model of temporomandibular joint (TMJ) bony ankylosis for future evaluation of surgical reconstructive methods. MATERIALS AND METHODS: An animal model was selected on the basis of 2 sequential experiments. Four goats and 4 minipigs were used in the first experiment, in which 1 goat and 1 minipig served as control animals. Condylectomy with disc preservation was performed on 1 side of 3 animals in each group. On the contralateral TMJ, condylectomy with discectomy was performed, and the arthroplasty gap was filled with the autogenous bone chips. In the second experiment, TMJ ankylosis was induced bilaterally in 3 additional animals of the species that achieved better ankylosis results in the first experiment. All animals were killed postoperatively at 3 months, and the TMJ complexes were examined by plain radiography, computed tomography, and histological evaluation. RESULTS: In the first experiment, only fibrous ankylosis was observed in the bone-grafted side of 2 goats and 3 minipigs, whereas fibro-osseous ankylosis was achieved in the remaining goat. The extent of ankylosis was found to be more severe in the goats than the minipigs. Hence, goats were selected for bilateral surgery in the second experiment, which achieved consistent bony ankylosis of the TMJ in all animals. CONCLUSIONS: Goats provide a better TMJ bony ankylosis model than minipigs. Consistent bony ankylosis can be induced by bilateral condylectomy, disectomy, and bone grafting of the arthroplasty gap.