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

Objective: To present a case of bilateral temporomandibular joint ankylosis that was managed successfully through gap arthroplasty. Methods: Design: Case report Setting: Tertiary Government Hospital Patient: One Results: A 25-year-old man presented with inability to open his mouth for 18 years after direct trauma to his chin. CT scan showed bilateral bony fusion of condyles to glenoid fossae, hypertrophic sclerosis and fusion of the condylar heads to the temporal bones. He underwent bilateral gap arthroplasty via preauricular approach with creation of a 15 mm space on the mandibular fossa. As of latest follow up, the patient maintained an inter-alveolar distance of 30 mm for 5 months postoperatively, through continuous aggressive mouth opening exercises. Conclusion: Gap arthroplasty may be an efficient procedure for temporomandibular joint ankylosis in achieving satisfactory post-operative inter-alveolar opening and articular function. Early and meticulous rehabilitation is required to prevent relapse. Long-term follow up is recommended to document possible recurrence. Keywords: temporomandibular joint ankylosis, gap arthroplasty, TMJ ankylosis, ankylosis

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Modified Gap Arthroplasty and Myrhaug's Incision as a Treatment Option in Management of Temporomandibular Joint Ankylosis: A Study of 10 Cases

The Journal of Contemporary Dental Practice ◽

10.5005/jp-journals-10024-1049 ◽

2011 ◽

Vol 12 (4) ◽

pp. 295-300 ◽

Cited By ~ 1

Author(s):

Shalini Gupta ◽

Arvind Agarwal ◽

Brijesh Ruparelia ◽

Ajay Kubawat ◽

Sandeep Patel

Keyword(s):

Temporomandibular Joint ◽

Treatment Option ◽

Operating Time ◽

Mouth Opening ◽

Open Bite ◽

Coronoid Process ◽

Tmj Ankylosis ◽

Temporomandibular Joint Ankylosis ◽

Gap Arthroplasty ◽

Joint Ankylosis

ABSTRACT Purpose of the study The purpose of this study was to evaluate effectiveness of modified gap arthroplasty procedure and modified Myrhaug's preauricular incision for treating bony temporomandibular joint (TMJ) ankylosis. Materials and methods A total of 10 cases were included in the study with Sawhney's type III and IV TMJ ankylosis. Study consisted of 6 males and 4 females. Three cases were treated for bilateral ankylosis and 7 were treated for unilateral ankylosis. All the patients were treated with modified gap arthroplasty and modified Myrhaug's incision was used. In this modification, osteotomy cuts were modified in such a way that coronoid process was also removed simultaneously along with the osteotomized ankylosed mass in one piece. Results All the patients were followed up for 5 years and none of them presented with recurrence. Two patients had transient paresis to zygomatic and temporal branch of facial nerve and none had permanent damage to the nerve. Seven patients had mouth opening more than 25 mm (p) when followed for 5 years. Anterior open bite was seen in 4 patients and deviation of the jaw on ipsilateral side was noted in 2 patients. Conclusion Modified gap arthroplasty gave successful results in the follow-up period and eliminated the need of separate coronoidectomy. Use of modified Myrhaug's preauricular approach, provided excellent visibility particularly of the elongated coronoid process, minimized bleeding, prevented damage to the vital anatomical structures surrounding the joint and gave acceptable cosmetic results. Clinical significance The modified incision has been found to be reducing intra- and postoperative morbidity as well as provides excellent accessibility. The modified osteotomy technique eliminated the need for separate coronoidectomy thus significantly reducing the operating time. How to cite this article Agarwal A, Ruparelia B, Kubawat A, Patel S, Gupta S. Modified Gap Arthroplasty and Myrhaug's Incision as a Treatment Option in Management of Temporomandibular Joint Ankylosis: A Study of 10 Cases. J Contemp Dent Pract 2011;12(4):295-300.

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Management of temporomandibular joint ankylosis with combination of gap arthroplasty surgery and physiotherapy

Padjadjaran Journal of Dentistry ◽

10.24198/pjd.vol28no1.13518 ◽

2016 ◽

Vol 28 (1) ◽

Cited By ~ 1

Author(s):

Nurul Ramadhanty ◽

Alwin Kasim ◽

Abel Tasman ◽

Seto Adiantoro ◽

Dikki Drajat

Keyword(s):

Temporomandibular Joint ◽

Maxillofacial Surgery ◽

Surgical Techniques ◽

Mouth Opening ◽

Tmj Ankylosis ◽

Temporomandibular Joint Ankylosis ◽

Post Surgery ◽

Gap Arthroplasty ◽

Intensive Physiotherapy ◽

Joint Ankylosis

Background. Temporomandibular joint (TMJ) ankylosis is a union of the articular surface of the temporal bone to the disc-condyle complex that restricts mandibular movements due to either a fibrous or bony union between the head of the condyle and the glenoid fossa. Common etiological factors are trauma, infection, and pathology in the joint or systemic diseases. The diagnosis of TMJ ankylosis is established through physical and clinical evaluation, and imaging examination. Currently, the surgical techniques used to treat TMJ ankylosis are gap arthroplasty, interpositional arthroplasty, joint reconstruction, and distraction osteogenesis. Purpose. To provide overview about management of temporomandibular joint ankylosis with gap arthroplasty combined with physiotherapy post surgery. Case. A 12-year-old female patient came to Department of Oral and Maxillofacial Surgery with complaint of opening mouth restriction, which occured since one year prior to admission. After complete physical and radiographic examination, patient then was diagnosed with TMJ ankylosis due to neglected odontogenic infection. The treatment was performed with gap arthroplasty under general anesthesia. Patient then underwent physiotherapy after the surgery, including application of heat on the affected region and exercises to open and close mouth. Discussion. Ankylosis of TMJ is an uncommon case that results in chronic and severe limited mouth opening. The critical factor of successful treatment of TMJ ankylosis is early detection, correct surgery approach, implementation of an intensive physiotherapy program, and a good post-operative conduct. Therefore on this patient, gap arthroplasty was the chosen surgery approach followed by intensive physiotherapy. Conclusion.Management goal in TMJ ankylosis is to increase the patient’s mandibular function, correct associated facial deformity, decrease pain, and prevent reankylosis. Careful surgical technique and subsequent attention to physiotherapy are both considered essential to achieve a satisfactory result.

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Temporomandibular Joint Ankylosis Among Patients at Saint Paul’s Hospital Millennium Medical College, Ethiopia: a 9 Year Retrospective Study

10.21203/rs.3.rs-53966/v1 ◽

2020 ◽

Author(s):

Dereje Mekonnen ◽

Andamlak Gizaw ◽

Bruktawit Kebede

Keyword(s):

Temporomandibular Joint ◽

Medical Records ◽

Maxillofacial Surgery ◽

Mouth Opening ◽

Age Group ◽

Medical College ◽

Temporomandibular Joint Ankylosis ◽

Gap Arthroplasty ◽

Imaging Results ◽

Joint Ankylosis

Abstract Background: Temporomandibular joint ankylosis (TMJA) is a gradually developing pathological condition manifested by a limited mouth opening. It can result in an extremely disabling situation that may affect mastication, swallowing, speech, oral hygiene, and facial cosmetic appearance. The present study was aimed to determine the pattern of TMJA at St. Paul’s Hospital millennium medical college (SPHMMC), Addis Ababa, Ethiopia.Methods: A retrospective descriptive study design was conducted at SPHMMC. All medical records of patients with the diagnosis of TMJA that visited the Maxillofacial Surgery unit from September 2010 through August 2019 were reviewed. Clinical data including age, sex, place of residency, duration of the case, etiology, clinical presentations, imaging results, the type of operation and complications after surgery were collected, and analyzed by using SPSS version 20.0 windows software computer program. Results: A total of 130 patients’ medical records were reviewed. Out of this, 95 were included in the study. 42(44.2%) of the TMJA case were males, while the remaining 53(55.8%) were females with a female to male ratio of 1.26:1. The most affected age group was 20 to 39 years 36(37.9%), followed by the age group of 30 to 39 years 33(34.7%). Trauma was identified as the most common cause of TMJA. Notably, bilateral ankylosis was more common than unilateral, and mandibular deformity (micrognathia) was the most common deformity observed. The majority 52(54.7%) of TMJA patients were treated with Gap arthroplasty.Conclusions: Trauma was identified as the main cause of TMJA. The majority of TMJA cases were surgically treated with Gap arthroplasty with almost no postoperative complications. Thus early detection and intervention to release the ankylosed joint is needed to improve patient’s quality of life.

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