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

Axial CT of a young woman showing a unilateral bony ankylosis (c) of the right TMJ as results of previous facial trauma.

Intra-operative photograph showing periauricular incision (black arrow) with temporal extension (white arrow).

(a) Intra-operative photograph showing the 5th right rib while it was harvested (R); the harvested rib graft (CCG) has a short chondral portion (black arrow) and the osteochodoral junction is protected by the overlying periosteum. (b) Intra-operative photograph showing the temporalis myofascial flap (TMF) reflected over the zygomatic arch (Z), to serve as an interposition.

(a) Coronal CT showing right TMJ ankylosis, as a result of previous condylar fracture, notice the medial and lateral calluses (black arrows), and the condylar remnant (C). (b) Postoperative coronal CT showing the Unilab Surgibone xenogenic graft (G) fixed with 2 screws (arrows) to the lateral surface of the ramus (R) and articulating with the temporal bone (Z).

(a) Postoperative radiograph showing the coronoid process graft (G) fixed with bone plates and screws to the ramus stud and articulating with the temporal bone (Z). (b) Postoperative photograph showing satisfactory mouth opening after 12 months.

(a) OPG showing left TMJ ankylosis before resection and short left vertical ramus and the distraction device is activated. (b) A 17-month postoperative OPG after consolidation of the bony callus and resection of the ankylosis, notice maturation of the distracted left ramus and erupting wisdom teeth. (c) 17-Month postoperative frontal view showing excellent mouth opening and functioning articulation.