Ankylosis of the Temporomandibular Joint in Pediatric Patients

Abstract

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.

TMJ Ankylosis in Children: A Case Report and Literature Review

“…There is no expert consensus or published guidelines for the management of TMJ ankylosis [ 1 ]. However, some authors recommend the use of GA for Sawhney types I and II, and interposition arthroplasty for types III and IV [ 3 ]. Furthermore, a 7-step protocol for management of TMJ ankylosis in children was published in 2009.…”

“…The word “ankylosis” is of Greek origin ( ankylōsis which means stiffening of joints). Temporomandibular joint (TMJ) ankylosis involves the fusion of the mandibular condyle and the glenoid fossa, disc, and/or eminence [ 1 ], which often results in a significantly reduced mobility of the mandible clinically manifesting by the inability to achieve a maximum incisal opening (MIO) greater than 5 mm as well as limited, if any, mandibular protrusion or lateral excursions, disabled mastication, and difficulty with breathing, speech, nutrition, and oral hygiene [ 2 , 3 ]. Furthermore, childhood TMJ ankylosis often has a detrimental effect on the facial growth, resulting in facial asymmetry, mandibular micrognathia and bird-face deformity, and/or class II skeletal malocclusion with posterior or anterior open bite [ 4 ].…”

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“…Temporomandibular Joint Ankylosis (TMJA) is defined by bone and/or fibrous fusion of joint surfaces associated with limitation of masticatory function, nutritional imbalances and psychosocial changes [1][2][3]. Additionally, TMJA has a direct influence on craniofacial development due to the impairment of structural growth sites such as the mandibular condyle [4]. Specifically, craniofacial deformities are still related to dental malocclusions [3] and obstruction of airways, resulting in increased risk of recurrent infections and obstructive sleep apnea [5].…”

Custom-Made Alloplastic Prosthetic Implant to Treat Temporomandibular Joint Ankylosis in Pediatric Patients: A Case Study

“…TMJ ankylosis is usually investigated by clinical examination and with imaging studies such as CT or RMI [1][2][3][4][5]. TMJ ankylosis has been categorized into four different entities by Sawnhey et al, taking into account the severity of the situation and recommending a specific surgical treatment based on the type of the defect: Type I: Presence of fibroadhesions at the condyle; Type II: Bone fusion with condyle remodeling and an intact medial pole; Type III: Ankylotic mass, mandibular ramus union with the zygomatic arch and medial pole intact; Type IV: Complete ankylotic mass, total union of the mandibular ramus with the zygomatic arch [4,[6][7][8][9].…”