USE OF SILASTIC AS INTERPOSITIONAL MATERIAL IN THE MANAGEMENT OF UNILATERAL TEMPOROMANDIBULAR JOINT ANKYLOSIS
AbstractBackground: Ankylosis is a very common condition developed mainly after damage tomandibular condyles or temporomandibular joint (TMJ) at a growing age. Different autogenousand alloplastic interpositional materials have been attempted after the resection of the ankyloticbone to achieve desirable results. This condition is relatively common in Pakistan. We treatedTMJ ankylosis with alloplastic medical grade silicone “silastic” interpositional arthroplasty. Eightjoints accompanied ipsilateral or contralateral coronoidectomy to achieve desirable results.Method: All patients were presented at Punjab Dental Hospital Lahore. Sixty-one joints withunilateral TMJ ankylosis were underwent surgery after careful examination and final radiographicconfirmation. The preoperative CT scan was also performed in few patients. Results: Thepostoperative measurements of the interincisal opening with lateral and protrusive jaw movementswere criteria for success of surgery. The lateral and protrusive jaw movements were assessed asexcellent, good and poor. Less than 25 mm interincisal opening was considered as poor jawopening. Conclusion: The overall success rate was 98.4 % with 84 % desirable interincisal jawopening. Less than 5 % patients were observed with poor jaw opening. The immediate latecomplications were transient and were included oedema, weakness of a branch of the facial nerveon the operated side. Two implants were infected along with one wire in the first month of surgeryand were removed under local anaesthesia without further complication.Key words: Ankylosis, silastic, interpositional material, arthroplasty, coronoidectomy and jawmovements.
Walker RV. Arthroplasty of the ankylosis temporomandibular
joint. AM Surg. 1958; 24: (6).
Gallagher MD, Wolford LM. Comparison of silastic and proplast
implants in the TMJ after condylectomy for osteoarthritis. J Oral
Max Fac Surgery 1982; 40: 627-630.3. Akhtar MU, Ali K, Arain A, Mirza YB, Chaudhry Z.
Management of temporomandibular joint ankylosis: a long termcomparative study. J Coll Physicians Surg Pak 2001;2(11):84-7.4. Swanson AB. Finger joint replacement by silicone rubber
implants and its concept of implant fixation by encapsulation.
Ann Rheum Dis 1969; 28: 47-55.
Kreutziger KL, Mahan PE. Temporomandibular degenerative
joint diseases: diagnostic procedure and comprehensive
management. J Oral Surg 1975; 40: 297.
Posnick JC, Goldstein JA. Surgical management of the
temporomandibular joint in pediatric population. J Plastic
Reconst Surg 1993; 91: 5791-7.7. Gassner R, Tuli T, Hach O, Rudisch A, Ulmer H.
Craniomaxillofaical trauma: a 10 year review of 9543 cases with
injuries. J Craniomaxillofac Surg 2003;31(1):51-61.8. Iido S, Matsuya T. Pediatric maxillofacial fracture: their
etiological characters and fracture patterns. J Craniomaxillofac
Surg 2002; 30 (4):237-41.
Molla MR, Shrestha KR. An analytic study of surgical
management of temporomandibular joint ankylosis: an
experience in Bangladesh. Banglad Med Res Coune Bull 1996;22: 43-5010. Mofty EL. Ankylosis of temporomandibular joint. Oral Surg
; 33: 650-666.
Jeffrey J, Mose, Henry HLO. Fibrous Ankylosis of the
Temporomandibular Joint. J Orofacial Pain 1995; 9:381-384.
Kaban LB, Perott DH, Fisher K. A Protocol for Management of
Temporomandibular Joint Ankylosis. J Oral Max fac Surg 1990;
: 1145-1151.13. Adekeye EO. Ankylosis of the mandible: analysis of 76 cases. J
Silver MCM, Motamed M, Carlotti WE. Temporomandibular
joint with the use of vitallium condylar prosthesis: report of three
cases. J Oral Surg 1977; 35: 909.Oral Maxillofac Surg 1983; 41: 44215. Lei Z. Auricular cartilage graft interposition after
temporomandibular joint ankylosis surgery in children. J Oral
Max Fac Surg 2002; 60: 985-987.16. Saeed NR, Kent JN. A retrospective study of the costochondral
graft in TMJ reconstruction. Int J Oral Max Fac Surg 2003; 32:
Loon JP, de Bont LGM, Stegenga B, Spijkervet FKL, Verkerke
GJ. Groningen temporomandibular joint prosthesis: development
and first clinical application. Int J Oral Max Fac Surg
;31:44–5218. Steinhauser EW. The treatment of ankylosis in children. Int J
Oral Surg 1973; 2: 129.19. Kiersch TA. Proplast Teflon graft for TMJ surgery. VIII
international conference on oral surgery. Berlin, West Germany,
Verneuil A. De la creation d’une fausse articulation par section
of resection partielle de l’os maxillaire infericure, comme moyen
de remedier al’’nkylose vraie ou fausse de la machoire infereure.
Arch Gen Med 1872; 284-316.
Toyama M, Kurita K, Koga K, Ogi N. Ankylosis of the
temporomandibular joint developing shortly after multiple facial
fractures. Int J Oral Max Fac Surg 2003; 32: 360–362.
Akhtar MU, Ali K, Arain A, Mirza YB, Chaudhry Z. Rationale
for coronoidectomy in the management of temporomandibular
joint ankylosis. J Physicians Surgeons Pakistan 2001; 1(11): 12-14.