Classification and surgical management of temporomandibular joint ankylosis: a review

Abstract

The paper reviews various classifications and surgical techniques for the treatment of temporomandibular joint ankylosis. PubMed, EBSCO, Web of Science, and Google Scholar were searched using a combination of keywords. Articles related to classification, resection-reconstruction of the temporomandibular joint, and management of airway obstruction were considered and categorized based on the objectives. Seventy-nine articles were selected, which included randomized clinical trials, non-randomized controlled cohort studies, and case series. Though several classifications exist, most classifications are centered on the radiographic extent of the ankylotic mass and do not include the clinical and functional parameters. Hence there is a need for a comprehensive staging system that takes into consideration the age of the patient, severity of the disease, clinical, functional, and radiographic findings. Staging the disease will help the clinician to adopt a holistic approach in treating these patients. Interpositional arthroplasty (IA) results in better maximal incisal opening compared with gap arthroplasty, with no significant difference in recurrent rates. Distraction osteogenesis (DO) is emerging as a popular technique for the restoration of symmetry and function as well as for relieving airway obstruction. IA, with a costochondral graft, is recommended in growing patients and may be combined with or preceded by DO in cases of severe airway obstruction. Alloplastic total joint replacement combined with fat grafts and simultaneous osteotomy procedures are gaining popularity. A custom-made total joint prosthesis using CAD/ CAM can efficiently overcome the shortcomings of stock prostheses.

Are There Identifiable Risk Factors Associated With Heterotopic Ossification of the Temporomandibular Joint?

“…This classification was chosen as it was based on an orthopedic classification and did not focus on a specific etiology nor on the surgical management as other classifications have done. 22 This system was used to classify the severity of HO prior to the initial surgery to treat HO or at the time of diagnosis of HO. Data collected included age; gender; mandibular range of motion (ROM) in millimeters as measured between the incisal edges of the maxillary and mandibular incisors; pain intensity recorded on a 0-10 Likert-like numeric pain scale, where 0 indicates no pain and 10 indicates worst pain at the time of diagnosis; medical conditions including a musculoskeletal (MSK) disease (fibromyalgia, degenerative joint diseases), rheumatological condition (RA, psoriatic arthritis, systemic lupus erythematous, Sjogren syndrome, polymyalgia rheumatica, ankylosing spondylitis), congenital disorder (hemifacial microsomia, Nager syndrome, syngnathia, unspecified mandibular hypoplasia), neurogenic condition (encephalitis, epilepsy, cranial nerve VII damage), chronic headache disorder, hypertension, thyroid disorder, respiratory disease, obstructive sleep apnea (OSA), gastrointestinal diseases, psychiatric disorders (anxiety, depression, other psychiatric disorders including psychotic episodes, bipolar disorder, attention deficit hyperactivity disorder, post-…”

“…More recently, Upadya et al reviewed various surgical techniques for the treatment of TMJ ankylosis and stated that interpositional arthroplasty resulted in better maximal incisal opening than gap arthroplasty with no significant differences in recurrence rates. 22 This retrospective case series review is designed to answer the following clinical question: In patients diagnosed with HO in or around the TMJ, are there identifiable candidate variables associated with this condition?…”

Role of Magnetic Resonance Imaging in Temporomandibular Joint Ankylosis - An Evaluative Study

“…Patients with unilateral or bilateral TMJ ankylosis (primary or recurrent)-Sawhney’s classification-Type I, II, III and IV. [ 15 16 ]…”

Temporomandibular Joint Ankylosis in a Girl Child: Immunochemical Evaluation of Tissue Material Obtained from Repeated Arthroplasty Surgeries

“…Regardless of the age of detection, surgery is the mainstay of patient management-gap arthroplasty, inter-positional arthroplasty, and joint reconstruction or total joint replacement. In younger patients, reconstruction with autogenous costochondral graft (CCG) has been advocated, due to the probable growth potential of the graft tissue [2,7,8]. Nonetheless, recurrence due to continued ankylotic changes post-surgery remain a frequently reported complication [9].…”