Outcome of Surgical Protocol for Treatment of Temporomandibular Joint Ankylosis Based on the Pathogenesis of Ankylosis and Re-Ankylosis. A Prospective Clinical Study of 14 Patients

Immediate versus Delayed Physiotherapy Protocol after the Management of Temporomandibular Joint Ankylosis by Conservative Gap Arthroplasty

“…Early and aggressive physiotherapy is recommended to disrupt and prevent intra-articular fibrosis, soft tissue contractions, and redevelop normal muscle function, which in turn can regain MIO and prevent re-ankylosis. (1,12,16,29) Following the release of ankylosis, there is usually a period of 2-3 weeks in which the patients are not capable to do active physiotherapy because of pain and swelling and they are blamed for lack of compliance in jaw exercise. (28) Furthermore, the main problem of immediate physiotherapy is that it may induce bleeding and hematoma formation that delays healing and increase the risk of wound breakdown and bone formation.…”

“…This is in accordance to many authors who stated that the delay in physiotherapy may carry a high risk in losing the achieved intraoperative MIO. (1,3,5,12) . However, because of adequate adherence to the physiotherapy protocol, the intraoperative MIO was successfully restored in group 2 at 12 months postoperative.…”

“…(3,11) Postoperative physiotherapy is considered another important factor in avoiding re-ankylosis. (1) Most physiotherapy protocols (1,3,5,12) are designed to start jaw exercises immediately after release of the ankylosis. But patients during immediate physiotherapy may suffer from intolerable pain, which may lead to inadequate cooperation for active jaw exercises.…”

Simultaneous gap arthroplasty and intraoral distraction and secondary contouring surgery for unilateral temporomandibular joint ankylosis

“…However, it is not easy to perform active physical therapy during the distraction period because of postsurgical pain or discomfort. For these reasons, a staged operation for TMJ ankylosis—comprising ankylosis release as the first surgery, and distraction as the second—has been proposed [ 7 – 9 ]. However, after reports of two successful cases of simultaneous gap arthroplasty and distraction [ 12 , 13 ] in 1999, many authors subsequently reported similar successes [ 14 , 15 , 17 ].…”

“…However, the best timing for the distraction is still controversial. Some authors have suggested that distraction should be performed after gap arthroplasty [ 7 – 9 ], while others have performed distraction first, followed by gap arthroplasty at the time of distractor removal [ 10 , 11 ]. Simultaneous gap arthroplasty and distraction osteogenesis for treatment of micrognathia in TMJ ankylosis has also been reported [ 12 – 15 ].…”