Intraoral treatment of ankylosis on the temporomandibular joint and reconstruction with a custom made joint prosthetic

Abstract

Background: Gun shot wounds (GSW) to the temporomandibular joint (TMJ) generate comminute fractures that cause sever complications such as temporomandibular ankylosis. This in turn generates pathological changes to the anatomical and physiological integrity of the joint, causing severe limitations to the mandibular joint movement. The conventional focus on treating ankylosis consists of extraoral surgical procedures to expose and visualise anatomical structures. Due to the proximity to vital anatomical structures, there are inherit risks associated with this procedure, including injury to the facial nerves and salivary fistulas. Objectives: Describe a case of intraoral surgical release of TMJ ankylosis, followed by a second surgery to reconstruct de TMJ with a custom-made Hoffman articular prosthesis. Methods: We present a 37-year-old male with a five-year history of a GSW to the left TMJ that was not treated at the time of the initial trauma. The patient presented TMJ ankylosis as a result of multiple unsuccessful surgical interventions to release the joint. In 2015, the patient was treated at Centro Policlínico, where he received intraoral surgery to release the ankylosis on the left TMJ and subsequent joint reconstruction using custom-made joint prosthetics in a second procedure. An intraoral approach was selected in order to preserve tissue that would allow fitting a TMJ prosthesis. Conclusions: Intraoral ankylosis release is a valid surgical technique with successful results in highly selected cases when performed by experienced surgeons. This technique spares tissue that can be later used to reconstruct the TMJ with a prosthesis.