TMJ Ankylosis Management: Our Experience

Objectives: Mandibular osteotomies and resection of the temporomandibular joint (TMJ) ankylosis are the mostly performed surgical procedures in the infratemporal fossa, which is in close proximity with the main trunk of the maxillary artery (MA). It is imperative to avoid the trunk or branches of the maxillary artery, otherwise, massive intraoperative or postoperative hemorrhage may develop. The goal of the study was to investigate the position of the maxillary artery in the infratemporal fossa and the lingula of the mandible.Methods: Significant landmarks were selected on the mandibles of formalin fixed cadavers, and the distances were measured between the maxillary artery and the bony landmarks with a digital caliper.Results: The average distances between the MA and the articular eminence, the medial cortex of the mandibular ramus, the inferior border of the pterygoid fovea and the mandibular notch were 1.67±0.48 mm, 5.38±2.47 mm, 16.84±1.74 mm, 2.94±0.52 mm, respectively. Course pattern of the MA at the subcondylar level was also mapped. In order to determine the position of the lingula, the average distances between the tip of the lingula and the mandibular notch, the inferior border of the ramus, the anterior margin of the ramus and posterior margin of the ramus were measured and found as 15.4±2.1 mm, 49.5±4.3 mm, 18.1±2.7 mm, 16.6±2.5 mm, respectively. No significant differences were found between the right and left sides, for all parameters.Conclusions: The studied parameters will assist and navigate clinicians to determine the anatomic proximity to the maxillary artery, and, minimize the risk of damaging the vessel. (Eur J Dent 2010;4:166-169)

Download Full-text

O.647 Interpositional arthroplasty in TMJ ankylosis

Journal of Cranio-Maxillofacial Surgery ◽

10.1016/s1010-5182(08)71771-2 ◽

2008 ◽

Vol 36 ◽

pp. S162

Author(s):

V. Costan ◽

D. Gogalniceanu ◽

V.-V. Costan ◽

C. Vicol ◽

V. Trandaflr

Keyword(s):

Tmj Ankylosis ◽

Interpositional Arthroplasty

Download Full-text

Surgical management of TMJ ankylosis in the pediatric population

Journal of Oral and Maxillofacial Surgery ◽

10.1016/0278-2391(91)90662-6 ◽

1991 ◽

Vol 49 (8) ◽

pp. 111

Author(s):

J.A. Goldstein

Keyword(s):

Surgical Management ◽

Pediatric Population ◽

Tmj Ankylosis

Download Full-text

ANQUILOSE DE ATM EM PACIENTE PEDIÁTRICO: RELATO DE CASO

International Journal of Science Dentistry ◽

10.22409/ijosd.v1i51.36605 ◽

2019 ◽

Author(s):

Rodrigo Figueiredo de Brito Resende

Keyword(s):

Correct Diagnosis ◽

Facial Asymmetry ◽

Radiographic Evaluation ◽

Autogenous Bone ◽

Mandibular Growth ◽

Tmj Ankylosis ◽

Joint Reconstruction ◽

Interpositional Arthroplasty ◽

Mandibular Retrusion ◽

Costochondral Graft

RESUMO: A anquilose da ATM caracteriza-se pela substituição dos tecidos articulares por tecido ósseo ou fibro-ósseo, gerando uma união entre os componentes ósseos da articulação, tal alteração gera comprometimento da função articular. A anquilose da ATM quando ocorre na infância pode prejudicar o crescimento mandibular, causando posteriormente uma assimetria facial severa entre outros. Sua etiopatogenia é variável, desde traumas até reações a injeções intra-capsulares de medicamentos.O correto diagnóstico só é obtido por meio de avaliação clínica e radiográfica, incluindo tomografia computadorizada e reconstruções em 3D-TC. Há diferentes modalidades cirúrgicas para seu tratamento, artroplastia em GAP, Artroplastia Interposicional utilizando-se da interposição de um material biológico ou não, e a reconstrução conjunta da ATM, com enxertia de osso autógeno ou prótese articular total, todas preconizando ressecção agressiva da massa anômala fibrosa e/ou óssea.O presente trabalho visa relatar cirurgia de remoção de massa anquilótica óssea em ATM no serviço de CTBMF do HFSE do RJ. Paciente do sexo feminino, 7 anos, melanoderma, AMI de 15mm, acesso Al-Kayat, ressecção de massa anquilótica óssea, coronoidectomia bilateral, revestimento com aba miofascial de temporal, enxerto autógeno costocondral. Paciente evoluiu com AMI de 35mm e acompanhamento de 2 anos. Demonstrando eficácia e previsibilidade do tratamento escolhido, segundo protocolo Kaban.Palavras-chaves: Anquilose de ATM; Enxerto Costocondral; ArtroplastiaInterposicional; Protocolo Kaban ABSTRACT: TMJ ankylosis is characterized by the replacement of the joint tissues by bone or fibro-osseous tissue, generating a union between the bone components of the joint, such alteration causes compromised joint function. TMJ ankylosis when it occurs in childhood may impair mandibular growth, causing severe facial asymmetry and mandibular retrusion, difficulty in phonation, among others. Its etiopathogenesis varies from traumas to reactions to intra-capsular injections of medications. Correct diagnosis is only obtained through clinical and radiographic evaluation, including computed tomography and 3DCT reconstructions. There are different surgical modalities for its treatment, GAP arthroplasty, Interpositional arthroplasty using the interposition of a biological material or not, and the joint reconstruction of TMJ, with autogenous bone excision or total joint prosthesis, all of which advocate aggressive resection of the anomalous mass fibrosis and / or bone. The present study aims to report bone ankylosis mass removal surgery in TMJ in the CTBMF service of the HFSE of RJ. Female patient, 7 years old, melanoderma, 15 mm AMI, general anesthesia, Al-Kayat access, bone ankylotic mass resection, bilateral coronoidectomy, temporal myofascial flap coating, autochondral costochondral graft. Patient evolved with 35mm AMI and 2 year post-operative follow-up. Demonstrating effectiveness and predictability of the treatment chosen, according to Kaban protocol. Keywords: TMJ ankylosis; Costochondral Graft, Interpositional Arthroplasty;Kaban Protocol

Download Full-text

Total joint reconstruction using computer-assisted surgery with stock prostheses for a patient with bilateral TMJ ankylosis

Maxillofacial Plastic and Reconstructive Surgery ◽

10.1186/s40902-019-0225-1 ◽

2019 ◽

Vol 41 (1) ◽

Cited By ~ 1

Author(s):

Seung-Hyun Rhee ◽

Seung-Hak Baek ◽

Sang-Hun Park ◽

Jong-Cheol Kim ◽

Chun-Gi Jeong ◽

...

Keyword(s):

Surgical Planning ◽

Virtual Surgery ◽

Computer Assisted ◽

Lower Margin ◽

Tmj Ankylosis ◽

Reconstruction Surgery ◽

Joint Reconstruction ◽

Virtual Surgical Planning ◽

Surgical Guides ◽

Cad Cam

Abstract Backgrounds The purpose of this study is to discuss the total joint reconstruction surgery for a patient with recurrent ankylosis in bilateral temporomandibular joints (TMJs) using three-dimensional (3D) virtual surgical planning, computer-aided manufacturing (CAD/CAM)-fabricated surgical guides, and stock TMJ prostheses. Case presentation A 66-year-old female patient, who had a history of multiple TMJ surgeries, complained of severe difficulty in eating and trismus. The 3D virtual surgery was performed with a virtual surgery software (FACEGIDE, MegaGen implant, Daegu, South Korea). After confirmation of the location of the upper margin for resection of the root of the zygoma and the lower margin for resection of the ankylosed condyle, and the position of the fossa and condyle components of stock TMJ prosthesis (Biomet, Jacksonville, FL, USA), the surgical guides were fabricated with CAD/CAM technology. Under general anesthesia, osteotomy and placement of the stock TMJ prosthesis (Biomet) were carried out according to the surgical planning. At 2 months after the operation, the patient was able to open her mouth up to 30 mm without complication. Conclusion For a patient who has recurrent ankylosis in bilateral TMJs, total joint reconstruction surgery using 3D virtual surgical planning, CAD/CAM-fabricated surgical guides, and stock TMJ prostheses may be an effective surgical treatment option.

Download Full-text

A Triad of Temporomandibular Joint Ankylosis, Mandibular Retrognathia and Severe Obstructive Sleep Apnoea: Case report

Sultan Qaboos University Medical Journal [SQUMJ] ◽

10.18295/squmj.2018.18.03.019 ◽

2018 ◽

Vol 18 (3) ◽

pp. 379 ◽

Cited By ~ 1

Author(s):

Issa K. Al-Nuumani ◽

Abdulaziz Bakathir ◽

Ahmed Al-Hashmi ◽

Mohammed Al-Abri ◽

Hussein Al-Kindi ◽

...

Keyword(s):

Case Report ◽

Temporomandibular Joint ◽

Obstructive Sleep Apnoea ◽

Mouth Opening ◽

Sleep Apnoea ◽

Temporomandibular Joint Disorders ◽

University Hospital ◽

Tmj Ankylosis ◽

Obstructive Sleep ◽

Mandibular Retrognathia

The surgical management of paediatric patients with temporomandibular joint (TMJ) ankylosis, mandibular retrognathia and obstructive sleep apnoea (OSA) is challenging. We report a nine-year-old boy who presented to the Department of Oral Health, Sultan Qaboos University Hospital, Muscat, Oman, in 2016 with complaints of limited mouth opening, loud snoring and excessive daytime sleepiness. He was diagnosed with TMJ ankylosis, mandibular retrognathia and severe OSA. The patient initially underwent mandibular distraction and, subsequently, release of the TMJ ankylosis and rib graft reconstruction. The overall patient outcome was successful, with improvement in OSA-related symptoms, good facial symmetry and adequate mouth opening.Keywords: Temporomandibular Joint Disorders; Temporomandibular Ankylosis; Retrognathia; Obstructive Sleep Apnea; Case Report; Oman.

Download Full-text

True bony TMJ ankylosis in children: Case report

International Journal of Surgery Case Reports ◽

10.1016/j.ijscr.2019.06.037 ◽

2019 ◽

Vol 61 ◽

pp. 67-72

Author(s):

Rawaa Y. Al-Rawee ◽

Ali Mohammad Saeed Al-Khayat ◽

Saud salim Saeed

Keyword(s):

Case Report ◽

Tmj Ankylosis

Download Full-text

Use of vascularised cartilage as an additional interposition in temporomandibular ankylosis surgery: Rationale, advantages and potential benefits

Indian Journal of Plastic Surgery ◽

10.1055/s-0039-1699250 ◽

2008 ◽

Vol 41 (02) ◽

pp. 110-115

Author(s):

Mukund Jagannathan ◽

Maksud Devale ◽

Prashantha Kesari ◽

Siddharth Karanth

Keyword(s):

Temporomandibular Joint ◽

Articular Surface ◽

Superficial Temporal Artery ◽

Mouth Opening ◽

Temporal Artery ◽

Long Term Results ◽

Success Rates ◽

Tmj Ankylosis ◽

Potential Applicability ◽

Bony Segment

ABSTRACT Context: Surgery for the release of temporomandibular joint (TMJ) ankylosis is a commonly performed procedure. Various interposition materials have been tried with varying success rates. However, none of these procedures attempt to recreate the architecture of the joint as the glenoid surface is usually left raw. Aims: We aimed to use a vascularised cartilage flap and to line the raw surface of the bone to recreate the articular surface of the joint. Settings and Design: There is a rich blood supply in the region of the helical root, based on branches from the Superficial Temporal Artery (STA), which enables the harvest of vascularised cartilage from the helical root for use in the temporomandibular joint. Materials and Methods: Two cases, one adult and the other a child, of unilateral ankylosis were operated upon using this additional technique. The adult patient had a bony segment excised along with a vascularised cartilage flap for lining the glenoid. The child was managed with an interposition graft of costochondral cartilage following the release of the ankylosis, in addition to the vascularised cartilage flap for lining the glenoid. Results: The postoperative mouth opening was good in both the cases with significant reduction in pain. However, the long-term results of this procedure are yet to be ascertained. Conclusions: The vascularised cartilage flap as an additional interposition material in temporomandibular joint surgery enables early and painless mouth-opening with good short-term results. The potential applicability of this flap in various pathologies of the temporomandibular joint is enormous.

Download Full-text