Protocol for Multi-Stage Treatment of Temporomandibular Joint Ankylosis in Children and Adolescents

Abstract

Treatment of temporomandibular ankylosis is challenging and frequently leads to re-ankylosis, relapse, dangerous complications and, in turn, the need for multiple operations. In this article, we present a protocol for the treatment of ankylosis of the temporomandibular joints that assumes earlier intervention with the assistance of 3D virtual surgical planning (3DVSP) and custom biomaterials for better and safer surgical outcomes. Thirty-three patients were treated due to either uni- or bilateral temporomandibular ankylosis. Twenty individuals received temporomandibular prosthesis, whereas seventeen required simultaneous 3D virtual surgical/planned orthognathic surgery as the final correction of the malocclusion. All patients exhibited statistically significant improvements in mouth opening (from 1.21 ± 0.74 cm to 3.77 ± 0.46 cm) and increased physiological functioning of the mandible. Gap arthroplasty and aggressive rehabilitation prior to temporomandibular prosthesis (TMJP) placement were preferred over costochondral autografts. The use of 3DVSP and custom biomaterials enables more precise, efficient and safe procedures to be performed in the paediatric and adolescent population requiring treatment for temporomandibular ankylosis.

Repeated Intra-Articular Administration of Platelet-Rich Plasma (PRP) in Temporomandibular Disorders: A Clinical Case Series

“…It should be noted here that the analgesic efficacy of intra-articular PRP injections is based on the correct identification of joint pain and distinguishing it from ailments of myofascial origin, which can also be treated but with other methods [ 1 , 4 , 19 , 20 , 21 ]. Limits in the mobility of the mandible suitable for injection therapy should, in turn, be differentiated from mechanical obstacles resulting from fractures with blockage of the fragments, misplacement of the osteosynthetic material, and the consequences of injuries including ankylosis [ 22 , 23 , 24 , 25 ].…”

Intra-Articular Injections into the Inferior versus Superior Compartment of the Temporomandibular Joint: A Systematic Review and Meta-Analysis

“…The severity of the above, along with imaging tests, allows for classifying the internal derangement stage [ 8 , 9 , 10 , 11 , 12 ]. Depending on the severity of the temporomandibular disorders, treatment regimens consist of pharmacotherapy, physiotherapy, occlusal rearrangement (including splint therapy), intra-muscular injections, intra-articular injections, and arthroplasty [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ].…”

The role of physiotherapy interventions in the management of temporomandibular joint ankylosis: a systematic review and meta-analysis

“…Therabite device Gap and interpositional arthroplasty using the temporalis muscle flap effectively manage TMJ ankylosis Braimah et al (2018)/ [ 19 ] Retrospective study 36 13.8 ± 6.6 To evaluate the TMJ ankylosis management approach Trauma due to a fall Bony and fibrous ankylosis Effective therapy requires intensive postoperative physiotherapy for six months. Preventing re-ankylosis requires jaw physiotherapy Active physiotherapy is essential for managing TMJ ankylosis Dowgierd et al (2022)/ [ 20 ] Single-center prospective cohort study 33 14.24 ± 3.23 To outline TMJ ankylosis treatment Inflammatory, trauma, and congenital or iatrogenic Early intervention approach for temporomandibular ankylosis in children and adolescents using 3D virtual surgical planning and customized biomaterials Before temporomandibular prosthesis insertion, intensive physiotherapy improves mandible function Gap arthroplasty and thorough therapy before temporomandibular prosthesis outweighed costochondral autografts Elgazzar et al (2010)/ [ 35 ] Clinical retrospective study 101 19.43 To explore the experience of managing TMJ ankylosis and compare the outcomes of different protocols Trauma, previous TMJ surgery, osteoarthritis, hyperplasia, and infection Bony, fibrous, and ankylosis - Physiotherapy was a vital part of the treatment - Patients were encouraged to continue mouth-opening exercises at home. massage, and deep heat therapy Timely TMJ ankylosis release, bone grafting during ramus height reconstruction, and vigorous physiotherapy are efficient management approaches for TMJ ankylosis Erol et al (2006)/ [ 36 ] Clinical study 59 18 ± 6.4 To explore the experience of managing TMJ ankylosis Otitis media, Rheumatoid Arthritis, landslide, traffic accident, birth forceps trauma, and falls Bony and fibrous ankylosis P...…”