TEMPOROMANDIBULAR JOINT ANKYLOSIS: EXPERIENCE WITH INTERPOSITIONAL GAP ARTHROPLASTY AT AYUB MEDICAL COLLEGE ABBOTTABAD
Abstract
Background: Satisfactory surgical correction of temporomandibular joint ankylosis (TMA) islimited by a high recurrence rate, particularly in patients who underwent surgery without use of
interpositional material. The present study describes our experience of Interpositional Gap
Arthroplasty in patients presenting with primary or recurrent TMA. Methods: The study was
conducted on 12 patients presenting at the Oral and Maxillo-Facial Surgical Unit of the Ayub
Medical College Abbottabad from 1999 to 2004. Interpositioning materials used included
Temporalis fascia, Temporalis muscle, Silastic sheet and Cartilage (Costochondral) graft. Pre- and
Postoperative assessment of temporomandibular joint (TMJ) mobility was done by clinical
assessment of jaw movement and measurement of interincisal distance by vernier calipers; X-rays
were done to document complications such as fibrosis and ankylosis. Results: Nine of the 12
patients (75%) were new cases of ankylosis, while the remaining 3 (25%) had one, three and four
prior operations. Duration of ankylosis ranged from 9 months to 12 years. Ankylosis was bilateral
in 8 cases (66.7%) and unilateral in 4 cases (33.3%). Operative findings were simple bony
ankylosis in 13/20 jaws (65%), soft tissue fibrosis in 4/20 jaws (20%) and massive bony growth in
3/20 jaws (15%). Preoperative interincisal distances ranged from 0-15mm; immediate
postoperative distances ranged from 20-40 mm; one-month and six-month postoperative distances
ranged from 25-50 mm. All patients had an uncomplicated outcome till six months follow up; one
patient developed reduced mouth opening to 12 mm at one year follow up due to parental
noncompliance with mouth exercises; one patient developed infection and extrusion of silastic
sheet at 2.5 years follow up. Conclusion: Interpositional Gap Arthroplasty is a highly effective
and safe surgical management option for TMA with acceptable immediate and long term outcome,
particularly when temporalis fascia and muscle are used for adults and costochondral grafts with
fascia interposition used for children.
Key Words: Temporomandibular Joint, Ankylosis, Temporal Muscle, Arthroplasty.
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