TMJ ANKYLOSIS

The feat of surgery of TMJ ankylosis with various surgical techniques by the Department of Oral and Maxillofacial Surgery of Saraswati Dental College in the capital Lucknow will prove to be a milestone in the coming days.

Temporomandibular joint (TMJ) ankylosis refers to the fibrous or bony fusion between the condyle and fossa or heterotopic bone surrounding the joint. It usually develops before the age of 10 years, but could develop at any age. When this condition occurs during the growing years, it can severely affect jaw growth and development. In 2011-12, a population-based door to door survey, showed that the overall prevalence of TMJ ankylosis in Lucknow is 0.46 per 1,000 children. TMJ bony ankylosis usually develops as a result of trauma, inflammation, sepsis, and/or systemic diseases causing severely limited jaw function as well as oral hygiene and nutritional problems. Perinatal trauma from forceps is considered as a historical cause as well. Children are susceptible to a post-traumatic ankylosis. The main clinical features of TMJ ankylosis are progressive limitation of mouth opening, facial deformity, decreased growth on the involved side and obstructive sleep apnea syndrome. Patients usually present with limitation of mouth opening and a maximum interincisal distance of 0–10 mm. This condition eventually causes aesthetic defects in the face, malocclusion, and facial malformation, particularly during childhood.

A 2-stage protocol has been developed for the treatment of TMJ ankylosis: 1) Gap arthroplasty, Coronoidectomy bilaterally, Interposition with temporalis myofascial flap and Costochondral graft 2) After six months: distraction osteogenesis and orthognathic procedures after patient is 18 years old. The total joint prosthesis is a superior technique relative to prevention of re-ankylosis, provide jaw and occlusion stability, improve function and facial balance, and eliminate or decrease pain. 

The growth studies showed that very young children who underwent surgery for congenital ankylosis showed greater growth of their mandibles than the mandibles in children who underwent surgery at a later age and also their postoperative mandibular growth rate was nearly the same as that observed in normal adults. So, one of the principles of the management of TMJ ankylosis is to operate as early as possible. Early detection and early intervention to release the ankylosed joint minimizes the severity of the restriction of facial growth, risk of facial asymmetry; development of mental and social stress thus preventing psychosocial problems and produces a healthy citizen who can further take the nation to highest growth.

For last 5 years we have done more than 57 TMJ Ankylosis cases successfully with an average of 8-10 number of cases per year using various treatment protocols with a very good outcome.