Treatment modalities of TMJ ankylosis: experience in Delta Nile, Egypt☆

Abstract 

The study reports the authors’ experience in managing TMJ ankylosis in Delta Nile, Egypt (1995–2006) and compares the surgical modalities used. 101 patients (109 joints) were reviewed in this retrospective study. Pre- and postoperative assessment included history, radiological and physical examination, and mouth opening. Age, sex, aetiology, joint(s) affected, surgical modality, complications and follow up periods were evaluated. Various types (fibrous, fibro-osseous and bony) of TMJ ankylosis were diagnosed; trauma was the commonest aetiology. The patients’ age range was 2–41 years, 62% were female, and the follow up period ranged from 14 to 96 months. Average mouth opening was significantly increased from 5.3mm pre-operatively to 32.9mm 12 months postoperatively (P=0.0001). Marked improvement in mouth opening was documented when the ramus-joint complex was reconstructed using distraction osteogenesis (34.7mm), costochondral graft (34.4mm) and Surgibone (34.6mm). Gap arthroplasty showed least satisfactory mouth opening compared with other techniques (P=0.001). Minor and major complications were encountered in 33% of cases, including 5% recurrence rate. Early release of TMJ ankylosis; reconstruction of the ramus height with distraction osteogenesis or bone grafting combined with interpositional arthroplasty, followed by vigorous physiotherapy is successful for managing TMJ ankylosis.

Keywords: temporomandibular joint, ankylosis, Egypt, surgery, gap arthroplasty, interpositional arthroplasty, mandibular reconstruction, distraction osteogenesis