Arthroplasty in temporomandibular joint (TMJ) ankylosis is managed by three basic techniques; gap arthroplasty, interpositional arthroplasty and joint reconstruction. In this three-year, prospective study of 15 patients, the authors evaluate whether or not aggressive gap arthroplasty is essential in the management of ankylosis of the TMJ. Of the 15 patients (17 joints), 12 had unilateral and three had bilateral involvement, with trauma being the most common cause. A minimal gap of 5-8mm was created in all 15 patients and interpositional gap arthroplasty was achieved by insertion of temporalis fascia. Eleven patients had unilateral coronoidectomy and four had bilateral coronoidectomy based on Kaban's protocol. Preoperative assessment included recording of history, clinical and radiological examinations, personal variables, the aetiology of the ankylosis, the side affected, and any other relevant findings. Patients were assessed postoperatively by a surgeon unaware of the treatment given for a minimum of three years, which included measurement of the maximal incisal opening, presence of facial nerve paralysis, recurrence, and any other relevant findings. Preoperative maximal incisal opening was 0-2mm in eight cases and 2-9mm in nine. Postoperatively adequate mouth opening of 30-40mm was achieved in all cases, with no recurrence or relevant malocclusion during three-year follow-up. The authors conclude that aggressive gap arthroplasty is not essential in the management of ankylosis of the TMJ and that minimal gap interpositional arthroplasty with complete removal of the mediolateral ankylotic mass is a feasible and effective method of preventing recurrence.
Minimal gap interpositional arthroplasty versus aggressive gap arthroplasty in TMJ ankylosis
Reviewed by Sampath Chandra Prasad
Is aggressive gap arthroplasty essential in the management of temporomandibular joint ankylosis? – a prospective clinical study of 15 cases.
