Purpose: To evaluate sternoclavicular graft (SCG) as an adaptive centre for temporomandibular joint (TMJ) reconstruction in TMJ ankylosis.
Patients and methods: A retrospective analysis of 27 cases of ankylosed temporomandibular joint during the period of 2002–2012 was under taken. All patients had complete osseous ankylosis. Interpositional arthroplasty with SCG along with or without BFP lining was done in all cases. All cases were analyzed for functional adaptation of the graft, considering maximum interincisal opening, and protrusive and laterotrusive movement of the jaw. Radiological evaluation was carried out at regular intervals for 2–3 years to assess the anatomical adaptation of the graft.
Results: Significant improvement was noticed in all cases except one, although maximum improvement was seen 3–6 months postoperatively, patients maintained their mouth opening in further follow up visits. During follow up maximum interincisal opening was 35.6 ± 4.97 mm (range, 31–45 mm). Similarly, protrusive movement at follow-up was 2.7 ± 1.25 mm (range, 1.5–5.5 mm), whereas laterotrusive movement was 4.1 ± 1.98 mm (range, 1.5–7.0 mm) toward the affected side and 2.4 ± 0.99 mm (range, 1–4.0 mm) toward the normal side. On radiographic follow-up, there was noticeably significant adaptation and remodelling of SCG as observed on panoramic radiography and computed tomography scan. In all the patients there was some degree of mandibular deviation toward the operated side, although the occlusion was satisfactory. No major postoperative complications were observed and maximum cases showed complete regeneration of the clavicle during follow up.
Conclusion: On the basis of the findings of this study, we conclude that after release of TMJ ankylosis, reconstruction with SCG combined with interposition of BFP lining followed by vigorous physiotherapy is a successful strategy for the management of TMJ ankylosis.