Trauma, systemic diseases, or infections mainly cause it. The etiologies of tmj ankylosis include previous trauma, previous tmj surgery. Epidemiology and natural progression of articular temporomandibular disorders. It can be classified according to location intra or extraarticular, type of tissue involved bone, fibrous, or fibro. Ankylosis can result from trauma, as a result of local and systemic infections or due to systemic disease, such as ankylosing spondylitis, rheumatoid arthritis, and psoriasis. Interrelationship between size and tissueseparating potential of costochondral transplants. When ankylosis leads to arrest of condylar growth, facial asymmetry is common see mandibular condylar hyperplasia. Temporomandibular joint tmj ankylosis is a bony or fibrous adhesion of the anatomical joint components by an ankylotic mass, with a manifestation of limited mouth opening jain et al. Bony ankylosis of the bilateral tmjs and associated mpd ankylosis of the tmj has a variety of etiologies but eventually results in fusion of the mandibular condylar head to the glenoid fossa. Ankylosis can also occur as a result of previous tmj surgery matsuura et al. The use of the temporalis muscle flap in facial and craniofacial reconstruct ive surgery. Pdf textbook of oral and maxillofacial surgery second.
Case by prof dr varghese mani mds, trichur institute of head and neck surgery, keralaankylosis of the temporomandibular joint is a condition affecting the masticatory system that ranges from. Functional restoration by gap arthroplasty in temporomandibular joint ankylosis a report of 50 cases. Officebased anaesthesia has been instrumental within the evolution of patient surgery. It is formed by the articulation of the glenoid fossa of the temporal bone and the head of the condyle. The treatment is stretching exercises in the early stages of the cartilagous calcification and later, surgery, to restore the jaw movement. Anaesthesia for tmj ankylosis with the use of tiva. Diagnosis of temporomandibular joint tmj ankylosis in. Temporomandibular ankylosis is a condition that occurs when the temporomandibular joint the joint that connects the jaw to the side of the head becomes fused by bony or fibrous tissue. Ankylosis joint stiffness is the pathological fusion of parts of a joint resulting in restricted movement across the joint ankylosis of the temporomandibular joint, an arthrogenic disorder of the tmj, refers to restricted mandibular movements hypomobility with deviation to the affected side on opening of the mouth. Page 1 of 9 bds final professional examination 2007 oral surgery mcqs model paper marks. Surgery may be used to treat tmj disorder if more conservative treatments arent working. Surgery for disorders of the temporomandibular joint.
The nuances of temporomandibular joint ankylosis surgery. Treatment of ankylosis is one of the greatest challenges in temporomandibular joint tmj surgery. Surgery for disorders of the temporomandibular joint july 1, 2005 by taylor p. Temporomandibular joint is the articulation between squamous part of temporal bone and the head of mandibular condyle. The treatment of tmj ankylosis consisted of surgery in 5 cases 83%.
Presentation on ankylosis joint musculoskeletal system. As a result, affected people may experience pain, speech impairment, and difficulty chewing and swallowing. Bony ankylosis of the temporomandibular joint tmj in a male patient was not diagnosed until the patient reached his early teens, at which time the condition was treated with a costochondral graft. Temporomandibular joint tmj ankylosis involves the fusion of the mandibular condyle to the glenoid fossa, the skull base. Tmj is the most active ball and socket joint used in about 2000 hinge and sliding motions per day such as talking swallowing kissing etc. Another technology that lends itself to complex tmj surgical procedures such as ankylosis is imageguided surgery. Ankylosis of the tmj is exceptional, and to our knowledge only 11 cases have been reported to date. Total tmj reconstruction consists of replacing the articulating surfaces of both the glenoid fossa of the temporal bone and the mandibular condyle. Retrospective analysis of a tmj ankylosis protocol with a. Evaluating the remodeling of condyles reconstructed by. Ankylosis of the temporomandibular joint tmj is a disabling condition in mastication, speech, facial expression, pain, and oral hygiene, resulting in compromise of patients quality of life 1,2. When ankylosis leads to arrest of condylar growth, facial asymmetry is common see mandibular. Temporomandibular joint tmj ankylosis is a disabling condition of mastication in which the condylar movement is limited by a mechanical problem in the joint true ankylosis or a mechanical cause not related to the joint components false ankylosis.
Tmj reconstruction is required during endstage joint disease that is when a joint is so negatively affected architecturally by disease or trauma that causes severe physical impairment. This technology, although developed either for intracranial surgery or ear, nose, and throat surgery, is directly applicable to tmj surgery. Today, dr sunil richardson and his team have helped her to eat solid food stuff after a. Case reports in medicine hindawi publishing corporation. Temporomandibular ankylosis genetic and rare diseases. Initial signs often include lumbosacral pain and discomfort with limited range of movement. This report describes the multidisciplinary phasewise treatment of a 20yearold female patient having unilateral right tmj bony true ankylosis whose mouth opening was restricted to 2 mm and mandibular retrognathism.
The more unusual causes include rheumatoid arthritis, sickle cell anaemia and fibrodysplasia ossificans progressiva. All 6 patients with tmj ankylosis had trismus, and half of them reported feeding or speaking difficulties. Management of young patients with temporomandibular joint. This smart kid is unable to open her mouth for the last 5 years, inspite of a joint surgery done elsewhere. Tmj ankylosis is a rare disorder due to the fusion of the mandibular condyle at the cranial base. Treatment also varies if ankylosis is unilateral or bilateral. Temporomandibular joint was exposed through a pretragal approach, and local osteotomies or ostectomies were performed. Selective embolization for total replacement of the. Thus, tmj ankylosis may occur posttrauma or postsurgery.
Oral and external body part surgeons specifically have maximized the advantages of officebased anaesthesia and have contributed greatly to its evolution. Anatomy the tmj is a diarthrodial, ginglymus, synovial joint that is capable of both rotational and translatory movements. To provide a satisfactory mouth opening, as well as normal jaw function, and to prevent reankylosis in the long term are the most important principles in the treatment of tmj. At right tmj, gap arthroplasty was performed through the preauricular approach figure 2. To study the effectiveness of fat grafting on joint replacement surgery, this study took 32 patients who had a total of 48 stiff joints. Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics. The sequential treatment of temporomandibular joint. Usually bony tmj ankylosis is treated with gap arthroplasty which leads to shortening of ramus height unless reconstructed.
If affected in early years of life, it may cause facial dysmorphism, restricted mouth opening, and difficulty in eating, speech, and sleep. Johan served as professor in the department of maxillofacial and oral surgery at the university of the witwatersrand. Surgeons with the department of oral and maxillofacial surgery at penn medicine are using a protocol with penn interventional neuroradiologists to prevent massive blood loss during total replacement of the temporomandibular tmj joint in advanced ankylosis. Tmja is a very distressing structural condition that alters the. Oral surgery oral medicine oral patholgoy oral radiology and. A protocol for management of temporomandibular joint ankylosis. Surgical management of temporomandibular joint ankylosis. It can interfere with nutrition, oral hygiene and the normal growth of the face andor jaw. In the second edition of the book a detailed and authoritative exposition of basic principles of oral and maxillofacial surgery is presented in altogether 50 chapters under 12 sections. The preoperative and intraoperative mean interincisal opening mio was 4. The dilemma with regards to treatment planning whether distraction is done before gap arthroplasty or as a simultaneous procedure or after gap arthroplasty is still a controversy. Congenital temporomandibular joint tmj ankylosis is an uncommon condition that presents itself at or soon after birth in the absence of acquired factors that could have contributed to the ankylosis such as infection and trauma.
Correction of temporomandibular ankylosis oral health group. Download anesthesia considerations for the oral and maxillofacial surgeon. True ankylosis of the mandible is one of the most disturbing articular pathosis of tmj. When ankylosis leads to arrest of condylar growth, facial. Total alloplastic temporomandibular joint reconstruction. The initial surgery was accomplished under general anesthesia. False ankylosis may be caused by enlargement of the coronoid process, depressed fracture of the zygomatic arch, scarring from surgery, irradiation, infection, etc. Ankylosis of the temporomandibular joint tmj most often results from trauma or infection, but it may be congenital or a result of rheumatoid arthritis. Approximately 5,500 tmj total joint replacement procedures were performed in u.
After exposure and identification of the site of the ankylosis, aggressive excision of the fibrous andor bony mass was carried out with round bur and chisel until the mandibular movement was achieved. Pdf management of temporomandibular joint ankylosis. Temporomandibular joint ankylosis is a unique disease where fracture of the mandibular condyle or any other cause leading to ankylosis of the joint can lead to multiple problems if not detected and treated early. Tmj ankylosis is a functional disorder of the mandible that presents as varying degrees. Ankylosis may be defined as the fusion of joint surfaces. One of the types of tmj that can require surgical attention is temporomandibular joint ankylosis, in which the temporomandibular joint begins to seize up.
Temporomandibular joint tmj ankylosis is a serious condition that refers to adhesion of the mandibular condyle to the glenoid fossa and surrounding structures, leading to a loss of function and movement1, 2. If tmj ankylosis occurs during childhood, it may predispose patients to growth deformities, which can result in either a mandibular asymmetry deformity in unilateral tmj. Surgical treatment of posttraumatic ankylosis of the tmj. Page 1 of 9 bds final professional examination 2007.
Temporomandibular joint ankylosis tmja results in restricted mouth opening due to a fibrous or bony nonneoplastic union of the mandibular head to the glenoid fossa. In class iii tmj ankylosis the mandibular condyle is medially displaced. Progressive synovial changes eventually involve numerous axial joints. Ankylosis of the temporomandibular joint tmj dental. Long term effect of radiotherapy to oral mucosa is.