Temporomandibular joint ankylosis fixation technique with ultra thin silicon sheet

Abstract

Background:Temporomandibular joint ankylosis is a highly distressing condition in which the joint space is obliterated by scar tissue and the patient has an inability to open the mouth. Different autogenous and alloplastic interposition materials have been used after the resection of the ankylotic bone to achieve desirable and long lasting results. The recurrence of disease is most distressing for both patients and surgeon. We have been using ultra thin silicon sheet as our preferred material for providing proper fixation and cover to the joint. We have been encouraged by good patient compliance, no implant extrusion and favourable outcome.Materials and Methods:The clinical study included 80 patients with temporomandibular joint ankylosis, treated between April 2001 and March 2009. In all patients, temporomandibular joint ankylosis had resulted following trauma. Diagnosis was based on clinical assessment supplemented by radiographic examination consisting of a panoramic radiograph, axial and coronal computer tomography. The technique of using ultra thin silicon sheet covering whole of the joint space fixed with non-absorbable nylon 3-0 suture both medially to medial pterygoid muscle and laterally to periosteum of zygomatic arch was employed in all patients.Results:A total of 80 patients were in this study (59 males and 21 females). The aetiology of temporomandibular joint ankylosis was post-traumatic in all cases. The patients’ age ranged from 5 to 45 years. The disease was unilateral in 61 cases and bilateral in 19 cases. Twelve patients, who had previous surgery done in the form of gap arthroplasty in 6 cases, costochondral graft in 4 cases and temporalis muscle in 2 cases, presented with recurrence on the same side. The pre-op inter-incisal mouth opening ranged from 4 to 12 mm. The intraoperative inter-incisal mouth opening ranged from 28 to 46 mm. An additional procedure was done in 13 patients, including placement of costochondral graft with coronoidectomy in 4 of these cases. There was no immediate complication and no incidence of facial nerve injury. There was no extrusion of the implant in immediate and follow-up period.Conclusions:The use of alloplastic implants with less volume and proper fixation covering all the raw bone joint space prevents reunion of bone; fixation of the sheet prevents its movement and thus extrusion.

Facial Deformity in an Operated Case of Bilateral Temporomandibular Joint Ankylosis

“…Preoperative evaluation by computed tomography images was done in the present case. Gap arthroplasty, which involves removing the bony mass without using any inter-positional material, joint reconstruction, which involves removing the bony mass and reconstructing it using bone grafts or joint prosthesis, and inter-positional arthroplasty, which involves removing the bony mass and using either biological or non-biological material, are the fundamental surgical techniques for treating ankylosis [ 11 ].…”

Congenital cheek teratoma with temporo-mandibular joint ankylosis managed with ultra-thin silicone sheet interpositional arthroplasty

“…The fixation of the sheet reduces the chances of re-ankylosis by preventing displacement or extrusion of the implant. [10] The advantages were short operative time (1.5 h), minimal foreign body load in the joint space hence least chance of extrusion and no loss of mandibular height. Post-operative physiotherapy for about 1 year is as important as surgery if not more, in the overall outcome for patient.…”

Matrix-associated chondrocyte transplantation for reconstruction of articulating surfaces in the temporomandibular joint: a pilot study covering medium- and long-term outcomes of 6 patients

“…Gap arthroplasty with interposition of autologous tissues is still a method of TMJ ankylosis treatment widely used today: Temporalis muscle flaps 9, dermis-fat grafts 12, ear cartilage 13 or fascia lata 14, are the most important methods of autogenous reconstruction. Although there have been reports about foreign body reactions, alloplastic materials are still used for the permanent separation of free bone surfaces after gap arthroplasty 15. Alloplastic total joint reconstruction is the gold standard for treatment of TMJ re-ankylosis in case of multiple failed previous surgeries or systemic disease 7.…”