Background: Temporomandibular joint ankylosis (TMJA) is a severe disorder described as an intracapsular union of the disc–condyle complex to the temporal articular surface with bony fusion. The causes of ankylosis of the mandible can be classified as congenital, traumatic, inflammatory and neoplastic. Idiopathic forms including enlarged coronoid processes have been considered as causes of restricted mouth opening as a whole. The management of these disabilities are challenging and rarely based on surgical and rehabilitation protocols.
Methods: We describe the treatment in two young adults affected by Goldenhar syndrome and Pierre Robin sequence with reankylosis after previous surgical treatments. Moreover three cases of congenital idiopathic ankylosis in severe craniofacial deformities are reported. Details of intraoperative management and postoperative care are described.
Results: Surgical results in terms of post-operative mouth opening are reported in the different steps of the treatment. Our study also emphasizes the significance of three-dimensional CT techniques for diagnosis and surgical planning, the superiority of coronoidectomy over coronoidotomy and of the extraoral approach over the intraoral approach, and the importance of dynamic physiotherapy to prevent postoperative scar formation.
Conclusion: Management of TMJA is difficult as no surgical protocols have been suggested. Failure and reankylosis are common. In pediatric age the aim of surgery is to recover morphology and function with normal growth, appropriate speech development, dental occlusion, and normal development of the facial skeleton. The best treatment is yet to be found because no consensus in the literature has been established. Surgical treatment must be tailor-made for each patient and adequate post-operative rehabilitative physiotherapy protocol (RPP) is necessary to achieve success.
Key words : TMJ ankylosis; coronoid hyperplasia; trismus; rehabilitative physiotherapy; TMJ surgery