Recent Progress in Addressing Temporomandibular Joint Ankylosis

Abstract

TMJ ankylosis refers to the fusion of the mandibular condyle with the skull's base. Managing this condition is a formidable task due to technical complexities and a high recurrence rate.[1] Addressing temporomandibular ankylosis is a complex endeavor often resulting in reankylosis, relapse, risky complications, and necessitating multiple surgeries. This article introduces a treatment protocol for managing temporomandibular joint ankylosis, emphasizing early intervention using modern treatment approaches."

Temporomandibular joint (TMJ) ankylosis occurs when the disc-condyle complex fuses with the temporal articular surface within the joint capsule due to fibrous adhesions or bony fusion involving the condyle, disc, glenoid fossa, and eminence. This fusion can be caused by various factors such as trauma, chronic inflammation, or congenital disorders like ankylosing spondylitis, rheumatoid arthritis, arthrogryposis, and psoriasis. Among these factors, trauma is the primary cause of TMJ ankylosis. In instances of intracapsular fractures, the condylar head splits along a sagittal plane, with one fragment moving upwards over the outer rim of the glenoid fossa[2]. This disruption of the interarticular cartilaginous disc leads to a loss of mobility, potentially resulting in ankylosis

The approach to treatment varies depending on the patient's age. In young patients (eight years or younger), treatment focuses on restoring masticatory function and ensuring upper respiratory tract patency to enable normal breathing without a tracheostomy[3]. Additionally, comprehensive facial rehabilitation through temporomandibular joint reconstruction is a key objective.[4] For severely affected patients, a two-step treatment involving ankylotic mass resection and arthroplasty followed by distraction post-resection is recommended"In cases that are moderate or mild, removing the fused mass is usually enough[5]. Regardless of the initial severity, all patients require ongoing rehabilitation, speech therapy, orthodontic intervention, and regular monitoring for obstructive sleep apnea syndrome (OSAS) after mandibular movement is restored.

For individuals 14 years or older, the objective of treatment is to completely resolve the problem. Mandibular growth varies with age, involving specific growth spurts during childhood and adolescence[6]. Mandibular growth patterns affect arch shape, gonial angle, and other anatomical features. Mandibular growth is completed at different stages for females and males[7]. The mandible undergoes internal and external rotational adjustments that align with rotational changes in the maxilla[8]. Orthodontic treatment is crucial post-surgical procedures (resection, arthroplasty, and distraction) to optimize tooth eruption and support further orthodontic interventions[9]. Furthermore, surgical interventions might be required to support orthodontic procedures, like maxillary or mandibular distraction or extracting impacted teeth.[10] Customized orthodontic care, taking into account the patient's age, is crucial for orthognathic surgery and the placement of TMJ prostheses