Outcome of Surgical Protocol for Treatment of Temporomandibular Joint Ankylosis Based on the Pathogenesis of Ankylosis and Re-Ankylosis. A Prospective Clinical Study of 14 Patients

PurposeTrauma is the leading cause of temporomandibular joint (TMJ) ankylosis, and the treatment of this condition poses a considerable challenge because of the high incidence of recurrence. The author hypothesized that a treatment of ankylosis based on pathogenesis would result in a better outcome and a lower recurrence rate.Materials and MethodsThe author designed and implemented a prospective clinical study. The sample was composed of patients with TMJ ankylosis. The predictor variables were the affected side and patient age and gender. The outcome variable was maximal interincisal opening (outcome MIO). Descriptive and bivariate statistics were computed, and the P value was set at less than .05. The protocol consisted of the following steps: 1) perioperative indomethacin for 2 weeks; 2) the creation of a minimal gap of 5 to 10 mm; 3) ipsilateral coronoidectomy and (if required) contralateral coronoidectomy; 4) pterygomasseteric sling and temporalis muscle release; 5) interpositional dermis fat graft fixed to the condylar stump; 6) insertion of a suction drain; 7) immediate aggressive physiotherapy for at least 6 months; 8) regular long-term follow-up; and 9) delayed reconstruction using distraction osteogenesis.ResultsThe sample was composed of 14 patients (3 male and 11 female). Of these patients, 9 and 5 exhibited unilateral and bilateral ankylosis, respectively, and their ages ranged from 12 to 38 years (median, 18.5 yr). The follow-up period ranged from 24 to 48 months (mean, 32.5 months). Intraoperative MIOs ranged from 38 to 52 mm (mean, 45.7 mm). Postoperative MIOs exhibited a minor decrease in mouth opening (mean, 43.5 mm). The outcome MIOs ranged from 35 to 55 mm (mean, 43.5 mm). Of all patients, 21.4% developed temporary facial nerve paresis (grade II).ConclusionsThe results of the present study suggest that this surgical protocol is effective in the treatment of the TMJ ankylosis and the prevention of re-ankylosis.