Clinical experience in managing temporomandibular joint ankylosis: five-year appraisal in a Nigerian subpopulation

Abstract

Objectives: Temporomandibular joint ankylosis (TMJA) is a joint pathology caused by bony and/or fibrous adhesion of the joint apparatus, resulting in partial or total loss of function.

Materials and methods: This is a retrospective study conducted between 2012 and 2016 in the northwest region of Nigeria. The data retrieved includes gender, age, etiology of ankylosis, duration of ankylosis, laterality of ankylosis, type of imaging technique, type of airway management, types of incision, surgical procedure, mouth opening, interpositional materials used, and complications. Results were presented as simple frequencies and descriptive statistics.

Results: Thirty-six patients with TMJA were evaluated during the study period. There were 21 males (58.3%) and 15 females (41.7%), yielding a male:female ratio of 1.4:1. The patients' age ranged from 5 to 33 years with mean±standard deviation (13.8±6.6 years). Thirty-five cases (97.2%) were determined to be true/bony ankylosis, while only 1 case (2.8%) was false/fibrous ankylosis. Most of the TMJA cases (16 cases, 44.4%) were secondary to a fall. In our series, the most commonly utilized incision was the Bramley-Al-Kayat (15 cases, 41.7%). The mostly commonly performed procedures were condylectomies and upper ramus ostectomies (12 cases each, 33.3%), while the most commonly used interpositional material was temporalis fascia (14 cases, 38.9%). The complications that developed included 4 cases (11.1%) of severe hemorrhage, 1 case (2.8%) of facial nerve palsy, and 1 case (2.8%) of re-ankylosis.

Conclusion: Plain radiographs, with their shortcomings, still have significant roles in investigating TMJA. Aggressive postoperative physiotherapy for a minimum of 6 months is paramount for successful treatment.

Keywords: Ankylosis; Arthroplasty; Incision; Osteotomy; Temporomandibular joint.

Fig. 1. A. Three-dimensional (3D) computed tomography (CT) view of right temporomandibular joint ankylosis (TMJA). B. 3D CT view of left TMJA. C. CT coronal view showing right TMJA.

Fig. 2. A. Bramley-Al-Kayat incision for access to temporomandibular joint ankylosis (TMJA). B. Post-rami incision in gap arthroplasty for access to TMJA. C. Temporalis muscle/fascia for gap arthroplasty. D. Masseter muscle for gap arthroplasty.

Fig. 3. A. Ramus ostectomy for release of temporomandibular joint ankyloses (TMJA). B. Intraoperative inter-incisal distance achieved in TMJA.