TEMPOROMANDIBULAR JOINT ANKYLOSIS: EXPERIENCE WITH INTERPOSITIONAL GAP ARTHROPLASTY AT AYUB MEDICAL COLLEGE ABBOTTABAD
AbstractBackground: Satisfactory surgical correction of temporomandibular joint ankylosis (TMA) islimited by a high recurrence rate, particularly in patients who underwent surgery without use ofinterpositional material. The present study describes our experience of Interpositional GapArthroplasty in patients presenting with primary or recurrent TMA. Methods: The study wasconducted on 12 patients presenting at the Oral and Maxillo-Facial Surgical Unit of the AyubMedical College Abbottabad from 1999 to 2004. Interpositioning materials used includedTemporalis fascia, Temporalis muscle, Silastic sheet and Cartilage (Costochondral) graft. Pre- andPostoperative assessment of temporomandibular joint (TMJ) mobility was done by clinicalassessment of jaw movement and measurement of interincisal distance by vernier calipers; X-rayswere done to document complications such as fibrosis and ankylosis. Results: Nine of the 12patients (75%) were new cases of ankylosis, while the remaining 3 (25%) had one, three and fourprior operations. Duration of ankylosis ranged from 9 months to 12 years. Ankylosis was bilateralin 8 cases (66.7%) and unilateral in 4 cases (33.3%). Operative findings were simple bonyankylosis in 13/20 jaws (65%), soft tissue fibrosis in 4/20 jaws (20%) and massive bony growth in3/20 jaws (15%). Preoperative interincisal distances ranged from 0-15mm; immediatepostoperative distances ranged from 20-40 mm; one-month and six-month postoperative distancesranged from 25-50 mm. All patients had an uncomplicated outcome till six months follow up; onepatient developed reduced mouth opening to 12 mm at one year follow up due to parentalnoncompliance with mouth exercises; one patient developed infection and extrusion of silasticsheet at 2.5 years follow up. Conclusion: Interpositional Gap Arthroplasty is a highly effectiveand 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 withfascia interposition used for children.Key Words: Temporomandibular Joint, Ankylosis, Temporal Muscle, Arthroplasty.
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