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Case Reports
. 2024 May 22;16(5):e60828.
doi: 10.7759/cureus.60828. eCollection 2024 May.

Temporomandibular Joint Ankylosis in a Three-Year-Old Female: Anaesthesia, Airway Management, and Mandibular Distraction Osteogenesis

Amreesh Paul  1 , Anjali Borkar  1 , Dnyanshree Wanjari  1
Affiliations
Case Reports

Temporomandibular Joint Ankylosis in a Three-Year-Old Female: Anaesthesia, Airway Management, and Mandibular Distraction Osteogenesis

Amreesh Paul et al. Cureus. .

Abstract

Temporomandibular joint (TMJ) ankylosis is generally characterised by a complex aetiology, with several contributing causes, including infections, autoimmune diseases, trauma, and congenital anomalies. This case report describes a three-year-old female suffering from traumatic temporomandibular ankylosis with retrognathia, severe mouth-opening restriction, and obstructive sleep apnea (OSA). The present case highlights the difficulties with TMJ ankylosis, especially when access to healthcare is sought out late and delayed diagnosis is prevalent. Mandibular distraction osteogenesis and awake fiberoptic intubation were used in the surgical and anaesthetic management of this case, with the otorhinolaryngology team on standby to perform a tracheostomy if required, highlighting the necessity of a multidisciplinary approach in such cases. Patients with TMJ ankylosis have significant life-altering changes, including psychological stress, chewing difficulty, speech difficulties, facial distortion, and speech impediment. When OSA progresses, it also presents more health risks. For the purpose of treating TMJ ankylosis, avoiding serious problems, and enhancing patient well-being, prompt diagnosis and therapy are crucial. In order to optimise patient results, this case study highlights the need for knowledge and research in the treatment of TMJ ankylosis as well as the requirement of medical professionals working together in a synergistic way.

Keywords: difficult airway management; mandibular distraction osteogenesis; pediatric anesthesia; pediatric difficult airway; temporomandibular joint ankylosis.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Pre-operative image showing restricted mouth opening and retrognathia
Figures a, c - Showing restricted mouth opening; Figures b, d - Showing retrognathia.
Figure 2
Figure 2. Intra-operative image
A fiberoptic bronchoscope was introduced into the left nostril, and a flexometallic endotracheal tube was introduced into the right nostril.
Figure 3
Figure 3. Fiberoptic view of the glottis
ETT: Endotracheal tube The image shows the reinforced flexometallic endotracheal tube in situ.
Figure 4
Figure 4. Post-operative images after distraction
Images a, b, c, and d show improved mouth opening.
See this image and copyright information in PMC

References

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