Single-stage temporomandibular joint arthroplasty in a patient with complete bony ankylosis and previous extradural haematoma

Abstract

SUMMARYWe present a case of a man aged 20 years who was referred with the inability to open his mouth as a consequence of severe ankylosis of his temporomandibular joint. He had previously undergone an attempt to release the ankylosis at the referring institution; however, this was complicated by an extradural haematoma as a result of iatrogenic injury. We describe a one-stage procedure which provided safe excision of the ankylotic mass along with immediate total joint replacement with a custom implant. We advocate the use of preoperative vascular imaging along with the use of custom-made cutting guides to minimise vascular injury. BACKGROUND

Long-term follow-up after arthroplasty for pediatric temporomandibular joint ankylosis performed before the critical period of mandibular growth: A case report

“…In case of pediatric TMJ ankylosis, reconstruction of the mandibular head by rib cartilage grafting might be performed to take into consideration the growth of the mandible [12] . Furthermore, in case of re-ankylosis, reconstruction of the mandibular head using TMJ replacement prostheses might be necessary [13] . In the present case, no interpositional implant was used because strict postoperative mouth opening exercises and the displaced condylar process, which was maintained to almost normal TMJ structure, were expected to preserve the gap between the ramus and the zygomatic arch.…”

Interpositional Arthroplasty for Treatment of ATM Ankylosis

“…The Temporomandibular Joint (TMJ) is one of the most complex joints in the human body, its proper functioning determines the mandibular movements that are of great importance for relevant daily functions such as speech, chewing, mouth opening, breathing during sleep [1,2].…”

“…False ankylosis results from pathological conditions not directly linked to the joint [6] . The most common etiology is trauma followed by infection; rarely its cause is pathological such as rheumatoid arthritis, psoriasis, ankylosing spondylitis or joint neoplasia [2,7]. The treatment is performed surgically in order to restore its form and function [8], covering some options for approach such as: Opening arthroplasty Journal of Surgery: Open Access Open Access Journal (gap arthroplasty), Interpositional arthroplasty, ankylotic mass excision with ligament reconstruction [8].…”