This is a case of complete unilateral left side tmj ankylosis in a 27year old female who was not able to open her mouth for the past 22 years. Tmj ankylosis hypomobility causes, clinical features. The ankylosis of temporomandibular joint tmj is challenging problem for both patient and surgeon. Diagnosis of tmj ankylosis was based upon the clinical examination and plain radiography and ct scan. However, controversy remains as to whether ia is superior to ga. This surgical study done on 10 patients with tmj ankylosis were 5 patients had unilateral ankylosis and 5 had bilateral ankylosis.
Pdf comparative evaluation of gap arthroplasty and. Pdf temporomandibular joint tmj ankylosis is a disorder that leads to a restriction of the mouth opening from partial reduc tion to complete. Over 5 years and 4 months, she underwent gap arthroplasty and interpositional arthroplasty on her left tmj upon diagnosis of left tmj ankylosis. Dec 07, 2014 a 30year old nigerian male approached for correction of his locked jaw. Temporomandibular joint tmj ankylosis can be accompanied by various degrees of functional and esthetic problems. There are three basic techniques are currently employed. Rashedc and mamdouh sayeda aim the aim of this study was to evaluate the effect of temporomandibular joint bony ankylosis and surgical. Tmj bony ankylosis usually develops as a result of trauma, inflammation, sepsis, andor systemic diseases causing severely limited jaw function as well as oral hygiene and nutritional problems. Purpose the purpose of this study was to examine the effectiveness of gap and interpositional arthroplasty with temporalis muscle flap in the treatment of the temporomandibular joint tmj ankylosis. Pdf treatment of temporomandibular joint ankylosis. Treatment of temporomandibular joint ankylosis by gap arthroplasty.
Gap arthroplasty was first described by abbe in 1880. Multiple surgical modalities have been proposed to manage tmj ankylosis including gap arthroplasty, interpositional arthroplasty, and total joint. May gap arthroplasty versus interpositional arthroplasty for temporomandibular joint ankylosis. Association between the clinical features of and types of. Gap arthroplasty through a submandibular or preauricular approach coronoidectomy ipsilateral and possibly contralateral costochondral graft ccg with rigid internal. Gap arthroplasty versus interpositional arthroplasty for. Effect of temporomandibular joint bony ankylosis and surgical. The purpose of this study was to examine the effectiveness of gap and interpositional arthroplasty with temporalis muscle flap in the treatment of the temporomandibular joint tmj ankylosis. The basic principle in surgical release of ankylosis is the aggressive resection of the ankylotic mass.
Experience with interpositional gap arthroplasty at ayub medical college abbottabad iram abbas, muhammad jamil, muhammad jehanzeb, shah m ghous departments of oral and maxillofacial surgery, anaesthesia and radiology, ayub medical college abbottabad. Modified cut for gap arthroplasty in temporomandibular joint. Treatment of tmj ankylosis has been a topic of debate and the treatment options are. Effect of temporomandibular joint bony ankylosis and surgical sequelae of gap arthroplasty on middle ear volume mohammad dehisa, wahid h. Feb 14, 2014 gap arthroplasty extensive bony ankylosis. A variety of techniques for treatment of tmj ankylosis have been described in literature. Comparion of gap arthroplasty and interpositional gap arthroplasty on the temporomandibular joint ankylosis, the. Dermamatrix inserted as interpositional graft dermamatrix tissue synthes cmf temporomandibular joint gap arthroplasty postoperative management initial pain management, percocet.
Satisfactory surgical correction of temporomandibular joint ankylosis tma is limited by a high recurrence rate, particularly in patients who underwent surgery without use of interpositional material. Gap arthroplasty ga and interpositional arthroplasty ia are widely used for the. Pdf treatment of temporomandibular joint ankylosis by gap. This study evaluated the application of imageguided navigation to gap arthroplasty. This article describes a technique of gap arthroplasty in temporomandibular joint tmj ankylosis performed by transoral access. The treatment of tmj ankylosis by creating an adequate gap is of paramount importance in preventing any future recurrence and this can be achieved only when good access is gained to this complex anatomical joint. Gap arthroplasty with active mouth opening exercises using an. Jan 21, 2015 this is a case of complete unilateral left side tmj ankylosis in a 27year old female who was not able to open her mouth for the past 22 years. Temporomandibular joint ankylosis is a debilitating disease affecting the function, esthetics and psychology of the patient. This gap permits mobility the minimum gap should be 1cm to avoid re ankylosis 16. Bilateral gap arthroplasty and coronoidectomy were performed in this clinical study, and with the help of ios, the patient showed a mmo of 43 mm after 6 years fig. Longterm follow up is recommended to document possible recurrence. Gap arthroplasty with active mouth opening exercises using.
Neocondyle distraction was carried out in five patients with tmj ankylosis. Gap arthroplasty definition of gap arthroplasty by medical. Surgical treatment of temporomandibular joint ankylosis. Simultaneous gap arthroplasty and intraoral distraction and secondary contouring surgery for unilateral temporomandibular joint ankylosis aditi sharma1, junyoung paeng1, tomohiro yamada2 and taegeon kwon1 abstract background.
Material y methods eight patients eleven tmjs with tmj ankylosis were treated at the departament of oral and maxillofacial surgery at oswaldo cruz hospital, university of pernambuco, brazil all patients were treated by gap. Navigationguided gap arthroplasty in the treatment of. Jul 19, 2019 association between the clinical features of and types of temporomandibular joint ankylosis based on a modified classification system. Pdf the purpose of this paper is to show that gap arthroplasty improve mouth opening when treating tmj ankylosis. This technique is broadly termed gap arthroplasty and frequently employs the use of an interpositioning material to prevent recurrence. In our study, none of the patients were seen with recurrence after followup for 5 years. Management of adult unilateral tmj ankylosis with temporalis. When this condition occurs during the growing years, it can severely affect jaw growth and development. Temporomandibular joint ankylosis tmja is characterized by a limited. At age of 12 years he had a fall and subsequently had a progressive reduction of mouth opening. Postosteotomy and reconstructing temporomandibular joint figure 7. Iv treated by gap arthroplasty and found no recurrence in their series with a followup of at least 24 months. Modified gap arthroplasty and myrhaugs incision as a. Ultrasonic versus conventional gap arthroplasty for the.
The management goal in tmj ankylosis is to increase the patients mandibular function, correct associated facial deformity, decrease pain, and prevent reankylosis. Surgery of tmj ankylosis needs careful evaluation and planning to yield predictable results. Gap arthroplasty with intraoral distraction as a onestage treatment and subsequent contouring surgery can be applied to correct ankylosis with moderate. Ankylosis was induced in the right tmj by articular damage, disk removal and placement of a bone graft plus immobilization wire. Jan 23, 2019 ultrasonic versus conventional gap arthroplasty for the release of ankylosis of temporomandibular joint. Treatment of temporomandibular joint ankylosis by gap arthroplasty and interpositional arthroplasty. Review of literature concerning the tmj ankylo sis showed that this subject has received a consider able attention regarding etiology, epidemiology, di.
Therefore, we suggest that single or multistage treatment can be applied depending on the degree of malocclusion or occlusal instability, which is a reflection of tmj ankylosis severity. Gap arthroplasty of bilateral temporomandibular joint ankylosis. The temporomandibular joint ankylosis is divided into 2 types true and false. Ultrasonic versus conventional gap arthroplasty for the release of ankylosis of temporomandibular joint. A manual search was performed by screening the reference lists of. Gap arthroplasty, used in the treatment of temporomandibular joint tmj ankylosis, is challenging, requiring resecting of massive abnormal bone formation at the skull base with complex and distorted anatomy. Treatment of temporomandibular joint ankylosis with gap. Treatment of temporomandibular joint ankylosis by gap. The most commonly surgical approach used to restore normal joint functioning is a gap arthroplasty associated with the temporal muscle flap tmf as interpositional material.
Interpositional gap arthroplasty was found highly effective and safe surgical management option for tmj with acceptable immediate and long term outcome, particularly when temporalis fascia or muscle and iliac crest grafts were used for adults and costochondral grafts with fascia interposition used for children. To report 15 cases treated by either gap arthroplasty, or the articular reconstruction technique using costochondral. The true ankylosis is the intraarticular ankylosis and the false ankylosis is the extraarticular ankylosis. The section here consists of two horizontal osteotomy cuts removal of bony wedges for creation of a gap between the roof of the glenoid fossa and the ramus of the mandible. Surgical correction of the ankylosis only leaves the patient with an uncorrected mandibular deformity. This retrospective study was evaluated on 34 patients who were treated from february 2003 to july 2007. However, no single method has produced uniformly successful.
Vasconcelos bc, porto gg, bessanogueira rv 2008 temporo mandibular joint ankylosis. The present study describes our experience of interpositional gap arthroplasty in patients presenting with primary or recurrent tma. A metaanalysis junli ma 0 1 limin liang 0 1 hua jiang 0 1 bin gu 0 1 0 1 department of stomatology, guangzhou general hospital of guangzhou military command, guangzhou, guangdong, china, 2 department of stomatology, chinese pla general hospital, beijing, china 1 academic editor. This gap permits mobility the minimum gap should be 1cm to avoid reankylosis 16. Tmj ankylosis gap arthroplasty, temporalis interpositioning. Temporomandibular joint ankylosis is a common cause of acquired deformity in children. Gap arthroplasty in the treatment of temporomandibular joint. The purpose of this paper is to show that gap arthroplasty improve mouth opening when treating tmj ankylosis. Six patients with unilateral tmja from 2007 through 2011 were included in this.
Gap arthroplasty ga and interpositional arthroplasty ia are widely used for the treatment of temporomandibular joint ankylosis tmja. Simultaneous gap arthroplasty and intraoral distraction and. Temporomandibular joint tmj ankylosis during early childhood may lead to disturbances in growth and facial asymmetry and to serious. Brusati 6 and julie ann smith 5 used temporalis muscle in the treatment of tmj ankylosis and reported good functional results without any complication. Gap arthroplasty of temporomandibular joint ankylosis by. Eight patients with tmj ankylosis were treated by gap arthroplasty. The effect of gap arthroplasty on temporomandibular joint ankylosis. Pdf interposition gap arthroplasty of ankylosed tmj. Ankylosis may be corrected surgically by an array of procedures like gap arthroplasty, joint reconstruction and interpositional arthroplasty. Temporomandibular joint ankylosis tma is a highly distressing condition in which the temporomandibular joint tmj is replaced by scar tissue.
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