An epidemiological study of temporomandibular joint ankylosis

Evaluation of temporal fascia and dermal fat graft for temporomandibular joint ankylosis

The crippling disorder known as temporomandibular joint (TMJ) ankylosis is caused by the fusing of the mandibular condyle to the base of the skull, which results in limited mouth opening and severe functional impairment. In order to stop re-ankylosis, surgical care is essential and several interpositional materials have been tried. The therapy of TMJ ankylosis is compared in this research between dermal fat grafts and temporal fascia. Thirty patients with TMJ ankylosis in total were split into two groups at random. A temporal fascia graft was administered to Group A (n = 15), while a dermal fat transplant was administered to Group B (n = 15). The three main outcomes that were evaluated were the incidence of re-ankylosis, pain thresholds, and postoperative mouth opening. A Vernier caliper was used to measure the mouth openness, and the Visual Analog Scale (VAS) was used to gauge discomfort. One, three, and six months after surgery were the follow-up times. According to the research, dermal fat grafts may be a better option for treating TMJ ankylosis than temporal fascia grafts since them result in improved postoperative mouth opening, less discomfort, and a decreased chance of re-ankylosis. Both materials work well, however, and the patient's specific circumstances may influence the graft selection.

A systematic review of the clinical outcomes for various orthodontic and physiotherapy appliances used for the management of temporomandibular joint ankylosis

Ankylosis of the temporomandibular joint (TMJ) is associated with restricted mandibular movements, with deviation to the affected side. The management of TMJ ankylosis involves surgery to mitigate the effects of ankylosis, and adjunctive appliance therapy to supplement the results achieved through surgery. Several appliances have been used to help maintain jaw mobility postsurgery, but have been rarely documented in the literature. Our systematic review aimed to examine the clinical outcomes of various appliances for TMJ ankylosis management. A comprehensive electronic search of the literature was performed in July 2022 to identify eligible articles that had tested the use of orthodontic or physiotherapy appliances for the management of TMJ ankylosis. In total, 13 publications were included in the narrative synthesis. Both generic and custom-made appliances were used, with overall findings suggesting that using these appliances improved mouth opening and reduced chances of re-ankylosis. In this review no universally accepted appliance was found to be utilized, and the criteria used for appliance selection were unclear. The field of research in developing appliances for the treatment of TMJ ankylosis is open to advancement, and this review will help guide future research in this area.

Effectiveness of caudal segmental mandibulectomy in a cat: clinical and tomographic outcomes

Case summary

A 1-year-old spayed female domestic British Shorthair cat was presented for facial trauma; there were multiple mandibular fractures involving the right temporomandibular joint (TMJ) that were managed conservatively. After 2 months, the owner reported a gradual onset of the cat's inability to open its mouth and subsequent inappetence. The maximum mouth opening (MMO) measured 7 mm. CT showed ankylosis of the TMJ, and surgical treatment with caudal segmental mandibulectomy (CSM) was performed. The cat had a rapid postoperative recovery and returned promptly to spontaneous eating, with a nearly normal MMO of 33 mm. A CT scan performed 3 months postoperatively showed a mild rightward deviation of the mandible, and a clearly visible non-ossified ostectomy gap between the body and the ramus of the right mandible. The cat continued to eat spontaneously without dysphagia following surgery and was asymptomatic 1 year postoperatively.

Relevance and novel information

To the authors' knowledge, this is the first report describing the tomographic findings after CSM, as compared with the clinical outcome. Postoperative CT is indicated to confirm the success of the procedure and to assess TMJ ankylosis sequalae or complications of the CSM surgical site at an early stage. This report confirmed the effectiveness of CSM in resolving TMJ stiffness due to articular fractures or ankylosis with a good clinical and tomographic outcome.

Navigating Complexity in Mandibular Condyle Aplasia and Temporomandibular Joint Ankylosis in a Five-Year-Old Child: A Case Report

Mandibular condyle aplasia and temporomandibular joint (TMJ) ankylosis represent complex challenges in diagnosis and management, affecting jaw function and facial aesthetics. This case report presents a five-year-old female child with a right-sided small jaw and facial asymmetry due to left-sided TMJ ankylosis. The coexistence of mandibular condyle aplasia and TMJ ankylosis underscores the need for comprehensive evaluation and tailored treatment approaches. Syndromic associations, such as Goldenhar syndrome and Treacher Collins syndrome, further complicate diagnosis and management. Surgical intervention involving left-side gap arthroplasty and reconstruction using a costochondral graft/temporalis fascia was performed under general anesthesia. However, postoperative complications, including decreased mouth opening and left-sided lower motor neuron facial palsy, necessitated further surgical debridement and drainage of an abscess. The case emphasizes the importance of a multidisciplinary approach in addressing complex craniofacial anomalies, with treatment strategies such as bone grafting and tailored surgical interventions offering promising outcomes. Understanding the multifaceted etiology of mandibular condyle aplasia and TMJ ankylosis is crucial for optimal management, highlighting the collaborative efforts required for achieving favorable patient outcomes.

Managing Temporomandibular Joint Ankylosis Concurrent With Extrahepatic Portal Vein Obstruction: A Report of a Rare Case and Literature Review Investigating the Hypercoagulability Link

This report describes the understudied co-occurrence of temporomandibular joint ankylosis (TMJA) and extrahepatic portal vein obstruction (EHPVO), exploring a shared pathway involving hypercoagulability. TMJA is an acquired pathology where joint surfaces fuse, causing restricted mouth opening and facial asymmetry. Globally, TMJA is prevalent among 1.5 to 5 patients/million, with a higher incidence in developing countries. While trauma and infections often cause TMJA, the pathogenesis remains unclear in many cases. Recent literature notes a link between TMJA and EHPVO, a noncirrhotic vascular disorder causing portal hypertension and upper gastrointestinal bleeding in children. Prothrombotic disorders such as protein C and S deficiency may contribute to EHPVO, mirroring TMJA's association with hypercoagulability. This report focuses on an 11-year-old female diagnosed with TMJA, accompanied by a history of ear infection and concurrent EHPVO. We further presented clinical observations, surgical interventions, and outcomes alongside a literature review to understand the probable connection between EHPVO and TMJA.

Total temporomandibular joint replacement in recurrent temporomandibular joint ankylosis: a case report

Total temporomandibular joint replacement (TMJR) is a surgical procedure in which end-stage temporomandibular joint disorders are replaced with an alloplastic prosthesis between the mandible and the base of the skull when autogenous grafts are inadvisable. These alloplastic prostheses may be available as stock or custom-made prostheses consisting of the mandibular condyle and glenoid fossa components. Although the first total temporomandibular joint prosthesis was used in the 1960s, we present the case of a 20-year-old female patient, probably the first case of total temporomandibular joint arthroplasty in Nepal, performed at Dhulikhel Hospital in Kavrepalanchok. The patient underwent bilateral TMJR with a custom joint prosthesis for recurrent TMJ ankylosis. Postoperatively, the patient noticed significant improvements in mouth opening, chewing ability, facial esthetics and, most importantly, her self-esteem and confidence.

Modified Gap Arthroplasty for Temporomandibular Joint Ankylosis Following Radiotherapy for Rhabdomyosarcoma: Report of an Unusual Case and Brief Literature Review

Radiotherapy at the temporomandibular joint (TMJ) area often results in trismus, however, post radiation ankylosis is extremely rare and has not been previously reported in literature. Radiation is known to impact the vasculature of bony structures leading to bone necrosis with certain risk factors including surgical intervention, even teeth extraction, that could lead to osteoradionecrosis. Accordingly, gap arthroplasty for such case seemed rather challenging. In this report, we introduce for the first time, a rare case of temporomandibular joint ankylosis post radiotherapy for management of rhabdomyosarcoma in a 12 years-old boy. A modified gap arthroplasty technique combined simultaneously with pterygo-masseteric muscle flap was applied to lower the risk of osteoradionecrosis due surgical trauma at irradiated area. Computed tomographic scan on the head indicated that the TMJ architecture was completely replaced by bone, with fusion of the condyle, sigmoid notch, and coronoid process to the zygomatic arch and glenoid fossa. The patient’s problem was totally solved with no osteoradionecrosis or relapse of ankylosis observed at follow up visits. Herein, the modified gap arthroplasty combined with pterygo-masseteric muscle flap could be recommended to be applied on other cases of ankylosis especially after receiving radiotherapy.

Multidisciplinary management of temporomandibular joint ankylosis in an adult: journey from arthroplasty to oral rehabilitation

Ankylosis of the temporomandibular joint is a debilitating condition resulting in progressive trismus and facial disfigurement. Common trigger factors include paediatric mandibular trauma, middle ear infection or traumatic childbirth. Although diminishing in incidence among urban population, it is still prevalent in the underprivileged world. Substandard child safety norms, delayed presentation, lack of access to specialties like maxillofacial surgery in rural areas and absence of follow-up contribute to ankylosis. Afflictions in ankylosis are multipronged, involving aesthetic, functional, psychological and nutritional implications to name a few. The damage this pathology causes to the young mind and their morale is humongous. Although well documented, a complete presentation of cases with follow-up till oral and myofascial rehabilitation is seldom reported. This paper describes multidisciplinary management of a young female patient with temporomandibular joint ankylosis. Staged management commencing from interpositional arthroplasty until dental restoration with a 2-year follow-up is presented in this paper.

Mutations in the osteoprotegerin-encoding gene are associated with temporomandibular joint ankylosis

OBJECTIVE

This study aimed to investigate genetic variations in the osteoprotegerin-encoding gene (TNFRSF11B) in patients with temporomandibular joint ankylosis (TMJA).

STUDY DESIGN

The sample comprised 17 patients diagnosed with TMJA, of both sexes with ages ranging from 6 to 57 years old. TNFRSF11B mutational analysis was performed using the Sanger sequencing method with DNA extracted from oral cells, and the functional impact prediction of the variants was assessed using bioinformatic analysis.

RESULTS

Sequencing analysis identified 15 (88.23%) patients that presented at least 1 genetic variant in TNFRSF11B. The mutation rs202090603 (p.E33K) was found in 6 individuals, and rs140782326 (p.V281M), rs11573942 (p.L295), and rs1375250340 (p.I389T) were identified in 1 subject each. According to the pathogenicity potential of mutations, 3 variants were considered of low impact (rs2073618, rs202090603, and rs2228568) and 3 as disease causing (rs140782326, rs11573942, and rs1375250340). The variant rs202090603 (p.E33K) was found in the first cysteine domain with differences in the loop positions of p.E33K mutated the 3D structure of osteoprotegerin.

CONCLUSION

Two polymorphisms (rs2073618 and rs2228568) and the mutations rs202090603 (p.E33K), rs140782326 (p.V281M), rs11573942 (p.L295), and rs1375250340 (p.I389T) in the TNFRSF11B gene may be associated with TMJA.

Temporomandibular Joint Ankylosis among Patients at Saint Paul's Hospital Millennium Medical College, Ethiopia: A 9-Year Retrospective Study

Background

Temporomandibular joint ankylosis (TMJA) is a gradually developing pathological condition manifested by a limited mouth opening. It can result in an extremely disabling deformity that may affect mastication, swallowing, speech, oral hygiene, and facial cosmetic appearance. The present study aimed to determine the pattern of TMJA at St. Paul's Hospital millennium medical college (SPHMMC), Addis Ababa, Ethiopia.

Methods

A retrospective descriptive study design was conducted at SPHMMC. All medical records of patients with the diagnosis of TMJA that visited the Maxillofacial Surgery unit from September 2010 through August 2019 were reviewed. Sociodemographic and clinical data including age, sex, place of residency, duration of TMJA cases, etiology, clinical presentations, imaging results, type of surgical operation, and complications after surgery were collected and analyzed using IBM SPSS software version 20 for Windows (Armonk, NY, USA: IBM Corp) computer program.

Results

A total of 130 patients' medical records were reviewed. Out of this, 95 were included in the study. Forty-two (44.2%) of the TMJA cases were males, while the remaining 53 (55.8%) were females with a male to female ratio of 0.79 : 1. 20-29-year-old patients were the most affected, 36 (37.9%), followed by the 30 to 39 years age group, 33 (34.7%). Trauma (77.9%) was identified as the most common cause of TMJA. Notably, bilateral ankylosis (72.6%) was more common than unilateral (27.3%), and micrognathia was the most common (23.0%) deformity observed. The majority 52 (54.7%) of TMJA patients were treated with gap arthroplasty.

Conclusions

TMJA was predominant among females than their male counterparts. Of note, 20-29-year-old patients were the most affected group. The majority of TMJA cases were treated by gap arthroplasty with almost no postoperative complications. Early detection and intervention to release the ankylosed joint is needed to improve patients' quality of life.

Coronoidoplasty in TMJ ankylosis treatment

A 2-year-old boy was brought by his parents with complaints of difficulty in mouth opening for the past one and half years. He had difficulty in chewing and was malnourished, with developing facial asymmetry. He was diagnosed with right side temporomandibular joint ankylosis. We planned for surgical removal of the ankylotic mass. But we modified the treatment protocol. Instead of doing coronoidectomy after aggressive excision of the ankylotic mass as advocated by Kaban, we did a 'coronoidoplasty' after aggressive excision of the ankylotic mass. Coronoidotomy or coronoidectomy is one of the rungs in the treatment ladder that is followed in surgical management of temporomandibular joint ankylosis. But one of the postoperative complications after coronoidectomy is the open bite. The difficulty to close the mouth becomes more pronounced when bilateral coronoidectomy is done. However, 'coronoidoplasty', as we have done for this patient retains the action of the temporalis muscle on the mandible in closing the mouth, yet removes the mechanical interference of the coronoid process. Postoperatively the patient was able to clench his teeth well, chew properly and there was no open bite.

Dental Rehabilitation Following Surgical Management of Temporomandibular Joint Ankylosis: An Interdisciplinary Approach

Temporomandibular joint ankylosis (TMJ) is a condition affecting mastication, speech, appearance, and oral hygiene to a major extent. The disease is manifested by restriction to complete failure of the TMJ movement due to fibrous or bony union between the condylar head and glenoid fossa. This case report describes a case of a 13-year-old girl with inability to open the mouth along with fractured and discolored anterior teeth due to trauma. Patient was diagnosed as unilateral bony TMJ ankylosis left side and managed by surgical procedure interpositional arthroplasty followed by physiotherapy. Following satisfactory mouth opening, the required dental rehabilitation procedures were done. Combined efforts of pediatric dentists and oral and maxillofacial surgeon with a detailed history, clinical and radiographic assessment helps in correct diagnosis and providing immediate surgical intervention along with the management of associated dental complications in order to reestablish physical and psychological health of the child patient.

Ankylosis of the Temporomandibular Joint in Pediatric Patients

INTRODUCTION

While surgical interventions for temporomandibular joint (TMJ) ankylosis are well-documented, there is lack of consensus regarding the ideal approach in pediatric patients. Surgical interventions include gap arthroplasty, interpositional arthroplasty, or total joint reconstruction.

METHODS

A systematic review of PubMed (Jan 1, 1990-Jan 1, 2017) and Scopus (Jan 1, 1990-Jan 1, 2017) was performed and included studies in English with at least one patient under the age of 18 diagnosed with TMJ ankylosis who underwent surgical correction. Primary outcomes of interest included surgical modality, preoperative maximum interincisal opening (MIO) (MIOpreop), postoperative MIO (MIOpostop), ΔMIO (ΔMIO = MIOpostop - MIOpreop), and complications.

RESULTS

Twenty-four case series/reports with 176 patients and 227 joints were included. By independent sample t tests MIOpostop (mm) was greater for gap arthroplasty (30.18) compared to reconstruction (27.47) (t = 4.9, P = 0.043), interpositional arthroplasty (32.87) compared to reconstruction (t = 3.25, P = 0.002), but not for gap compared to interpositional (t = -1.9, P = 0.054). ΔMIO (mm) was greater for gap arthroplasty (28.67) compared to reconstruction (22.24) (t = 4.2, P = 0.001), interpositional arthroplasty (28.33) compared to reconstruction (t = 3.27, P = 0.002), but not for interpositional compared to gap (t = 0.29, P = 0.33). Weighted-average follow-up time was 28.37 months (N = 164). 4 of 176 (2.27%) patients reported development of re-ankylosis. There was no significant difference in occurrence of re-ankylosis between interventions.

CONCLUSIONS

Given the technical ease of gap arthroplasty and nonsignificant differences in ΔMIO, MIOpostop, or occurrence of re-ankylosis between gap and interpositional arthroplasty, gap arthroplasty should be considered for primary ankylosis repair in pediatric patients, with emphasis on postoperative physiotherapy to prevent recurrent-ankylosis.

Regenerative Sports Medicine: Past, Present, and Future (Adapted From the PASSOR Legacy Award Presentation; AAPMR; October 2016)

Regenerative medicine has shown dramatic expanse and evolution in the past decade. Within that milieu, physiatrists are taking an active role in research, clinical care delivery, and education. The purpose of this review is to provide a balance among evidence, theory, experience, clinical trends, and the foreseeable future. We focus on the literature that reports the research with the best methodology in each practice area, recognizing that the level of evidence varies substantially among different treatment modalities and conditions. The following elements are included: an overview of the evolution of currently available regenerative techniques, evidence base for each available modality (prolotherapy, platelet rich plasma, bone marrow aspirate concentrate and stem cells, adipose-derived stem cells, and amniotic tissue products), general principles in the application of these treatments, and discussion and a vision of what lies ahead. We expect that practitioners will use this review to facilitate clinical decision making and to provide a core knowledge base to assist when counseling patients. LEVEL OF EVIDENCE: IV.

Evaluation of Hemoglobin Concentration and Hematocrit Values in Temporomandibular Joint Ankylosis Patients in Comparison to Nonankylosed Patients

AIM

The aim of this study is to find if there is any correlation between the hematological parameters and temporomandibular joint (TMJ) ankylosis and severity of the disease in such patients when compared with the nonankylosed patients.

MATERIALS AND METHODS

A total of 70 patients with age ranging from 10 to 40 years were included in the study after excluding the subjects according to the inclusion criteria. We categorized the subjects into two major groups: group I: control (nonankylosed/ healthy subjects) and group II: study group (ankylosed subjects) with each group containing 35 subjects (n = 35) respectively. A detailed personal and medical history was obtained. The pharynx diameter was also recorded for each patient, and blood investigations using venous blood were done, which included hemoglobin concentration and hematocrit values.

RESULTS

The results of study population showed a mean age of 22 ± 2.2 years. The most common etiology reported was trauma (65.7%) followed by infections, in which Noma was the most common one (80%). The difference of the mean values for hemoglobin and hematocrit concentration, between both the groups, was found to be statistically significant (p < 0.0001). Furthermore, a positive correlation was observed between the hemoglobin concentration and duration of ankylosis.

CONCLUSION

This study was an attempt to find a relation between the hemoglobin and hematocrit values in TMJ ankylosis patients so that the clinical treatment and management of such patients during surgeries be improved and may be beneficial for the patient.

CLINICAL SIGNIFICANCE

Temporomandibular joint ankylosis patients have to undergo complex surgical treatment, where the risk of excessive blood loss is high. Therefore, considering the complications of blood transfusions, such as infections and other risk factors, these patients can be good subjects for autologous blood transfusions, which help in improvement of the overall well-being of the patient.

The autogenous graft versus transport distraction osteogenesis for reconstruction of the ramus-condyle unit: a prospective comparative study

This study aimed to compare the joint function and morphology achieved following condylar reconstruction using sternoclavicular grafts (SCG) versus transport distraction osteogenesis (TDO) in temporomandibular joint (TMJ) ankylosis patients. Twenty-two patients with TMJ ankylosis underwent TMJ reconstruction with SCG or TDO (n=11 each). Radiographic and clinical evaluations were performed at 1 week and at 1, 3, and 6 months post-surgery. Clinical criteria examined included the duration of surgery, mean postoperative mouth opening, excursive jaw movements, and pain scores. The radiographic evaluation 6 months postoperatively (computed tomography) included subjective assessment of joint morphology and measurements of the mean condylar height, width achieved, and amount of condylar resorption. The χ² test and Student t-test were used to compare qualitative and quantitative variables, respectively. Similar mean mouth opening (SCG=31.8mm, TDO=32.1mm at 6 months), excursive movements, and pain scores were observed in the two groups throughout follow-up. Mean condylar resorption was significantly greater in the TDO group (TDO=7.0mm, SCG=2.7mm; P=0.005). The duration of reconstruction surgery was greater in the SCG group (P=0.035). A greater incidence of complications was observed with TDO. In conclusion, based on the protocols used in this study, SCGs are superior to TDO in terms of condylar morphology, stability, and surgical safety.

Magnetic resonance imaging of the temporomandibular joint in children with juvenile idiopathic arthritis

For more than a century, it has been known that juvenile idiopathic arthritis (JIA) can affect the temporomandibular joint. With advances in medical imaging in more recent decades, there has been an increase in awareness of the spectrum of pathology that can affect the temporomandibular joint in children with JIA. This pathology can lead to symptoms ranging from decreased chewing ability, jaw and facial pain, headaches and malocclusion to craniofacial morphological changes such as a retrognathic mandible. The purpose of this review is to suggest an MR imaging protocol for the temporomandibular joint and to illustrate normal and abnormal appearances of the joint in children with JIA.