Objective: To assess the post-surgical outcome of six different surgical techniques for the management of ankylosis of the temporomandibular joint (TMJ).
Methods: Records of 467 joints undergoing surgery for ankylosis in the past ten years were examined. Patients were categorized into Group A: Gap arthroplasty only (GA) and Group B: GA+ interpositional arthoplasty (GAI). Group B was divided into five sub-groups. The primary outcome measure was maximal incisal opening. The aetiology, incidence of reankylosis and incidence of facial nerve palsy were assessed. Follow up was done on a regular basis.
Results: Group A included 147 joints and Group B included 320 joints. Interposition with temporalis and costochondral graft was performed in 82 joints, temporalis and coronoid process was used in 66 joints, temporalis flap only was done in 83 patients. Resected mass was used with conchal cartilage in 74 joints. Vertical ramal osteotomy (VRO) was done in 15 joints. Mean preoperative mouth opening of group A and group B was <10 mm. Mean intra-operative mouth opening of group A was 39.6 mm vs group B was 37 mm. Immediate mean post operative mouth opening was 30 mm in group A vs 24 mm in group B. The mean mouth opening one year post operatively in group A was 30.7 mm vs group B was 36 mm.
Conclusion: Patients in Group B showed significantly increased mouth opening after 1 year. Most common aetiology was childhood trauma.Transient facial nerve palsy was seen in 18% of patients. Reankylosis was seen in 10 patients. Temporalis only flap had the most predictable outcome. In children CCG showed favorable results. VRO best addressed the vertical dimension of the ramus.
Key words: TMJ ankylosis; gap arthroplasty; interpositional arthroplasty