Operative Management of Temporomandibular Joint Ankylosis: A Systematic Review and Meta-Analysis

PurposeTwo common treatments of temporomandibular joint ankylosis are gap arthroplasty and ankylosis resection and reconstruction of the ramus–condyle unit with a costochondral graft. The purpose of the present study was to answer the following clinical question: “Among patients with temporomandibular joint ankylosis, do those patients who undergo gap arthroplasty, compared with those who undergo ankylosis resection and ramus–condyle unit reconstruction with a costochondral graft have better postoperative mandibular range of motion?”MethodsA systematic search of the published data was performed to identify eligible studies. The primary predictor variable was treatment type (ie, gap arthroplasty or ankylosis resection and ramus–condyle unit reconstruction). The main outcome was the change in maximal incisal opening postoperatively. A random effects model was used to compute the pooled weighted mean difference between the pre- and postoperative maximal incisal opening in both treatment groups.ResultsFour studies met the inclusion criteria. Those undergoing gap arthroplasty had a significantly greater maximal incisal opening than the group undergoing ankylosis resection and ramus–condyle unit reconstruction. The weighted mean difference between the 2 groups was 2.4 mm (95% confidence interval 0.9 to 4.0; P = .002).ConclusionsSubjects with temporomandibular joint ankylosis who underwent gap arthroplasty had significantly better postoperative maximal incisal opening than those undergoing ankylosis resection and ramus–condyle unit reconstruction with a costochondral graft.