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

2016 ◽  
Vol 28 (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.

scholarly journals Gap Arthroplasty of Bilateral Temporomandibular Joint Ankylosis

2014 ◽  
Vol 29 (2) ◽  
pp. 28-31
Author(s):  
Ferdinand Z. Guintu ◽  
Alexander T. Laoag ◽  
Joselito F. David
Keyword(s):  
Temporomandibular Joint ◽  
Mouth Opening ◽  
Tmj Ankylosis ◽  
Temporomandibular Joint Ankylosis ◽  
Gap Arthroplasty ◽  
Long Term Follow Up ◽  
Preauricular Approach ◽  
Temporal Bones ◽  
Joint Ankylosis

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

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

2011 ◽  
Vol 12 (4) ◽  
pp. 295-300 ◽  
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.

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

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.

scholarly journals Frequency of Temporomandibular Joint Ankylosis in Various Age Groups with Reference to Etiology

2014 ◽  
Vol 13 (2) ◽  
pp. 17-20
Author(s):  
Mohammad Ali Hossain ◽  
Syed Adnan Ali Shah ◽  
Rajat Sanker Roy Biswas
Keyword(s):  
Temporomandibular Joint ◽  
Maxillofacial Surgery ◽  
Age Groups ◽  
Mouth Opening ◽  
Oral And Maxillofacial Surgery ◽  
Tmj Ankylosis ◽  
Temporomandibular Joint Ankylosis ◽  
Dental Hospital ◽  
Post Traumatic ◽  
Joint Ankylosis

Introduction: Temporomandibular joint ankylosis is a gradually developing condition manifested by mandibular hypomobility. Limitation of mouth opening can be caused by bony or fibrous ankylosis of the temporomandibular joint as sequel to trauma, infection, and autoimmune diseases. The purpose of this study was to determine the frequency of temporomandibular joint ankylosis in various age groups and to see the etiology of temporomandibular joint ankylosis.Materials & methods: This descriptive study study was carried out at the department of Oral and Maxillofacial surgery, de’Montmorency College of Dentistry / Punjab Dental Hospital, Lahore from September 2004 to August 2005 prospectively. A total 60 patients of various ages having TMJ ankylosis were included. Patients presented with TMJ ankylosis were assessed with detailed history and physical examination. Basic investigations including conventional radiographs and orthopentomogram were undertaken for every patient. Results: Females predominate with 35 (58.30%). Age ranged from 4 to 36 years and 11-20 years (60%) group predominating. In unilateral cases, left side involvement was more common in both males and females. TMJ ankylosis was post traumatic in 47(78.3%) cases followed by infection 7(11.7%) while birth trauma 2(3.3%) was rare. RTA was seen to the most frequent etiological factor followed by the fall.Conclusions: Temporomandibular joint ankylosis is a preventive entity if posttraumatic rehabilitation is instituted early and properly.DOI: http://dx.doi.org/10.3329/cmoshmcj.v13i2.21056

scholarly journals Auricular Cartilage Interposition Arthroplasty in Recurrent Temporomandibular Joint Ankylosis in Pediatric Patients

2021 ◽  
Vol 10 (1) ◽  
pp. 323-328
Author(s):  
Ahmad Liaquat ◽  
Arun Kumar Shah ◽  
Nabeela Riaz
Keyword(s):  
Temporomandibular Joint ◽  
Pediatric Patients ◽  
Maxillofacial Surgery ◽  
Mouth Opening ◽  
Cartilage Graft ◽  
Auricular Cartilage ◽  
Tmj Ankylosis ◽  
Temporomandibular Joint Ankylosis ◽  
The Mean ◽  
Joint Ankylosis

Background: Temporomandibular joint (TMJ) ankylosis in early childhood can lead to disturbances in growth, facial asymmetry and difficulties in eating as well as in breathing.  The objective of the study was to evaluate the effectiveness of auricular cartilage as an interpositional material after gap arthroplasty in pediatric patients with temporomandibular joint ankylosis in maintaining the achieved postoperative mouth opening. Material and Methods: This prospective study was conducted at the Oral and Maxillofacial Surgery Department of King Edward Medical University, Lahore, from 1st January 2019 to 30th November 2019. Thirty patients, aged 5 to 15 years with clinical and radiological diagnosis of TMJ ankylosis were included in the study. TMJ ankylotic mass was removed, the gap was created and interposition of auricular cartilage graft was done in these patients. Mouth opening was measured as a distance between the incisal edges of mandibular central incisors to maxillary central incisors using the scale. Preoperative and postoperative mouth opening was noted and compared using the paired t-test. Results: Among the thirty patients, 19 were male and 11 were female. The mean (±SD) age of patients was 9.23±3.23 years (age range 5 to 15 years). The mean preoperative mouth opening (T1) was 7.3±3.1 mm, while the mean postoperative mouth opening (T2) was 29.2±3.3 mm. The mean interincisal distance was 29.0 mm (range 21 mm to 35 mm). The mean difference in pre- and postoperative mouth opening (T2-T1) was 21.6 ± 5 mm. Conclusions: Autogenous auricular cartilage graft is an efficient and reliable interpositional material for achieving early postoperative mouth opening in TMJ ankylosis patients.

Coronoidoplasty in TMJ ankylosis treatment

2020 ◽  
Vol 13 (8) ◽  
pp. e235698
Author(s):  
Daniel Sathiya Sundaram Selvaraj ◽  
Ajish George Ommen ◽  
Jagadish Ebenezer
Keyword(s):  
Temporomandibular Joint ◽  
Treatment Protocol ◽  
Mouth Opening ◽  
Facial Asymmetry ◽  
Open Bite ◽  
Surgical Removal ◽  
Tmj Ankylosis ◽  
Temporomandibular Joint Ankylosis ◽  
The Past ◽  
Joint Ankylosis

A 2-year-old boy was brought by his parents with complaints of difficulty in mouth opening for the past one and half years. He had difficulty in chewing and was malnourished, with developing facial asymmetry. He was diagnosed with right side temporomandibular joint ankylosis. We planned for surgical removal of the ankylotic mass. But we modified the treatment protocol. Instead of doing coronoidectomy after aggressive excision of the ankylotic mass as advocated by Kaban, we did a ‘coronoidoplasty’ after aggressive excision of the ankylotic mass. Coronoidotomy or coronoidectomy is one of the rungs in the treatment ladder that is followed in surgical management of temporomandibular joint ankylosis. But one of the postoperative complications after coronoidectomy is the open bite. The difficulty to close the mouth becomes more pronounced when bilateral coronoidectomy is done. However, ‘coronoidoplasty’, as we have done for this patient retains the action of the temporalis muscle on the mandible in closing the mouth, yet removes the mechanical interference of the coronoid process. Postoperatively the patient was able to clench his teeth well, chew properly and there was no open bite.

Comparison of unilateral rostral, middle and caudal segmental mandibulectomies as an alternative treatment for unilateral temporomandibular joint ankylosis in cats: an ex vivo study

2020 ◽  
pp. 1098612X2097713
Author(s):  
Lenin A Villamizar-Martinez ◽  
Han Chia ◽  
James B Robertson ◽  
Cristian M Villegas ◽  
Alexander M Reiter
Keyword(s):  
Temporomandibular Joint ◽  
Ex Vivo ◽  
Surgical Techniques ◽  
Mouth Opening ◽  
Bony Tissue ◽  
Temporomandibular Joint Ankylosis ◽  
Vertical Range ◽  
Mandibular Body ◽  
Segmental Mandibulectomy ◽  
Joint Ankylosis

Objectives Temporomandibular joint ankylosis (TMJA) is the partial or complete inability to open the mouth due to intra- or extra-articular fibrous, bony or fibro-osseous tissue proliferation. Surgical procedures such as gap arthroplasty, condylectomy or wide extra-articular osteotomy have been recommended to treat this condition; these techniques are challenging, time-consuming and have been occasionally associated with postoperative recurrence, severe periarticular neurovascular iatrogenic trauma and death. Segmental mandibulectomy had previously been recommended as an alternative option for unilateral TMJA, but the location of mandibulectomy and extent of bone removal from the mandible region have not been mentioned in the literature. This study aimed to validate the area of the mandibular body (rostral, middle or caudal) and amount of bony tissue that should be osteotomized during a segmental mandibulectomy for treatment of unilateral TMJA in cats. Methods In this block study, 30 cadaver heads of domestic shorthair cats were randomly divided into three groups of 10 specimens each based on the mandibular region that would undergo segmental mandibulectomy (rostral, middle and caudal). The size of the removed mandibular segment and pre- and postoperative vertical range of mandibular motion were compared for statistical purposes. Results A significant statistical difference was observed between the pre- and postoperative vertical range of mandibular motion between the rostral, middle and caudal segmental mandibulectomies ( P <0.001). The mean postoperative recovered range of mandibular motion for the rostral, middle and caudal segmental mandibulectomies was 50.4%, 81.9% and 90.4%, respectively. Conclusions and relevance The caudal segmental mandibulectomy showed the highest postoperative vertical range of mandibular motion. The removal of a minimum of 1.2 cm of the caudal mandibular body was required to achieve nearly full recovery of presurgical mouth opening in the specimens of this study. The caudal segmental mandibulectomy may eliminate the risk of iatrogenic periarticular neurovascular damage inherent to more invasive surgeries performed at the temporomandibular joint area. When performed unilaterally, the caudal segmental mandibulectomy is a viable surgical alternative that may show a similar outcome to other surgical techniques.

scholarly journals Temporomandibular Joint Ankylosis among Patients at Saint Paul’s Hospital Millennium Medical College, Ethiopia: A 9-Year Retrospective Study

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Dereje Mekonnen ◽  
Andamlak Gizaw ◽  
Bruktawit Kebede
Keyword(s):  
Temporomandibular Joint ◽  
Medical Records ◽  
Maxillofacial Surgery ◽  
Old Patients ◽  
Female Ratio ◽  
Medical College ◽  
Temporomandibular Joint Ankylosis ◽  
Gap Arthroplasty ◽  
Imaging Results ◽  
Joint Ankylosis

Background. Temporomandibular joint ankylosis (TMJA) is a gradually developing pathological condition manifested by a limited mouth opening. It can result in an extremely disabling deformity that may affect mastication, swallowing, speech, oral hygiene, and facial cosmetic appearance. The present study 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. Sociodemographic and clinical data including age, sex, place of residency, duration of TMJA cases, etiology, clinical presentations, imaging results, type of surgical operation, and complications after surgery were collected and analyzed using IBM SPSS software version 20 for Windows (Armonk, NY, USA: IBM Corp) computer program. Results. A total of 130 patients’ medical records were reviewed. Out of this, 95 were included in the study. Forty-two (44.2%) of the TMJA cases were males, while the remaining 53 (55.8%) were females with a male to female ratio of 0.79 : 1. 20–29-year-old patients were the most affected, 36 (37.9%), followed by the 30 to 39 years age group, 33 (34.7%). Trauma (77.9%) was identified as the most common cause of TMJA. Notably, bilateral ankylosis (72.6%) was more common than unilateral (27.3%), and micrognathia was the most common (23.0%) deformity observed. The majority 52 (54.7%) of TMJA patients were treated with gap arthroplasty. Conclusions. TMJA was predominant among females than their male counterparts. Of note, 20–29-year-old patients were the most affected group. The majority of TMJA cases were treated by gap arthroplasty with almost no postoperative complications. Early detection and intervention to release the ankylosed joint is needed to improve patients’ quality of life.

Methods of Airway securing in patients treated for temporonandibular joint ankylosis

2021 ◽  
Author(s):  
Gelana Garoma ◽  
Ajay Prakash
Keyword(s):  
Temporomandibular Joint ◽  
Addis Ababa ◽  
Maxillofacial Surgery ◽  
Oral And Maxillofacial Surgery ◽  
Intubation Technique ◽  
Tmj Ankylosis ◽  
Temporomandibular Joint Ankylosis ◽  
Articular Disk ◽  
Addis Ababa University ◽  
Joint Ankylosis

Abstract Background: - Temporomandibular joint (TMJ) is a complex structure composed of several components including glenoid fossa of the temporal bone, the condylar head of the mandible, articular disk, as well as several ligaments and associated muscles. Its ankylosis causes distressing conditions including, both functional and aesthetic problems. An anesthetic management is challenging and surgery of TMJ ankylosis falls into the category of difficult airway as direct vocal cord visualization is difficult due to an inability to open the mouth. Fiberoptic intubation is considered as a safest approach and gold standard in TMJ ankylosis surgery as means of airway securing.Objectives: - The aim of this study was to assess method of airway securing in patients treated for temporomandibular joint ankylosis at Addis Ababa University Oral and Maxillofacial surgery affiliate Hospitals. Materials and Methods: - A retrospective cross sectional study was conducted in 22 patients (n=14 male and n=11 female) with mean age of 21.7(ranged 6-50) diagnosed with temporomandibular joint ankylosis at Addis Ababa University, Oral and Maxillofacial Surgery affiliate Hospitals both Yekatit 12 Hospital medical college and St. Peter specialized Hospital. Data was collected from patients’ medical records registered in a period of 3 years from January 2017 to December 2019. EPI- INFO 7 computer software was used for data analysis. Results: - The highest incidence of ankylosis was reported between the age of 11 and 20 (40.91%). Unilateral ankylosis was reported in (59.09%) and (68.18%) was bony ankylosis based on tissue involved. In majority 17 (77%) of patients tracheostomy was used as intubation technique and securing the airway and fibroptic technique is used only in 2(9%) patients. Conclusion: - The findings of this study tracheostomy was the most commonly used intubation technique, due unavailability of fibroptic and skilled professional in practice of other intubation techniques. Institutional capacity building of facilities, increasing service availability and experts for practice of fiberoptic and bland nasal intubation technique is recommended.

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