Modified Gap Arthroplasty for Temporomandibular Joint Ankylosis Following Radiotherapy for Rhabdomyosarcoma: Report of an Unusual Case and Brief Literature Review

Radiotherapy at the temporomandibular joint (TMJ) area often results in trismus, however, post radiation ankylosis is extremely rare and has not been previously reported in literature. Radiation is known to impact the vasculature of bony structures leading to bone necrosis with certain risk factors including surgical intervention, even teeth extraction, that could lead to osteoradionecrosis. Accordingly, gap arthroplasty for such case seemed rather challenging. In this report, we introduce for the first time, a rare case of temporomandibular joint ankylosis post radiotherapy for management of rhabdomyosarcoma in a 12 years-old boy. A modified gap arthroplasty technique combined simultaneously with pterygo-masseteric muscle flap was applied to lower the risk of osteoradionecrosis due surgical trauma at irradiated area. Computed tomographic scan on the head indicated that the TMJ architecture was completely replaced by bone, with fusion of the condyle, sigmoid notch, and coronoid process to the zygomatic arch and glenoid fossa. The patient’s problem was totally solved with no osteoradionecrosis or relapse of ankylosis observed at follow up visits. Herein, the modified gap arthroplasty combined with pterygo-masseteric muscle flap could be recommended to be applied on other cases of ankylosis especially after receiving radiotherapy.

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

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.

Temporomandibular joint reankylosis: A case report

Ankylosis of the temporomandibular joint (TMJ) occurs when the base of the skull fuses with condyle to the mandible. This can cause deleterious effects on the growth and development of the jaws and teeth when occurred in childhood. Recurrence of TMJ ankylosis is a known complication. Studies have contributed to the various treatment options in recurrent ankylosis. The causes of reankylosis of TMJ are due to inadequate gap arthroplasty, insufficient interpositional material, adhesion, and elongation of the coronoid process. This case report is about a 6-year-old female child who is not able to open the mouth. The child was diagnosed with TMJ reankylosis. The treatment consisted of gap arthroplasty with dermis-fat graft along with bilateral coronoidectomy followed by vigorous physiotherapy. Later, full-mouth rehabilitation with speech and functional therapy and psychological counseling was done. Treating TMJ ankylosis is challenging as it has technical difficulties and a high incidence of recurrence. Hence, the treatment is always a multidisciplinary approach inclusive of an oral and maxillofacial surgeon, a pediatric dentist, and a psychologist and a physical therapist.