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Management of issues following condylar fracture is dependent on the effect on joint function and pain and an assessment of the degree of deformity. The following article aims to guide the reader in the assessment of these issues and the preservation of as much as is normal as possible. “First do no harm” is a phrase coined from the writings of Hippocrates, the Greek philosopher and physician. The cases described illustrate examples of where other clinicians have advised joint replacement, but where the author has used orthognathic or less invasive techniques to preserve existing tissues and joint function and to restore facial balance. They serve as a reminder that the complete TMJ surgeon needs a good orthognathic knowledge and expertise.

Introduction: TMJ ankylosis (TMJa) management by arthroplasty alone fails to address the deformity and the compromised airway. Distraction osteogenesis (DO) can offer a pragmatic solution to TMJa. The aim of the study was to generate evidence towards the role of DO in TMJa, evaluate its efficiency and develop an algorithm for use of DO in TMJa. Material and methods: The research question was formulated using the PICOS statement for reporting guidelines in systematic reviews, where the efficiency of DO was evaluated in terms of mouth opening, correction of facial deformity and asymmetry, airway correction, and its long term effects. Results: 1130 articles reported DO as a treatment modality for TMJ ankylosis, of which 32 prospective studies, 16 retrospective and 2 RCTs were included in the study. DO was used for mandibular distraction in 45 studies and for simultaneous maxillamandibular distraction in only five studies. An algorithm for use of DO in TMJa was developed. Conclusion: Although DO has proven its application in TMJ ankylosis cases, its best use is for correction of obstructive sleep apnoea. Relapse causing loss of posterior ramal height is a concern after transport DO. Prearthroplastic DO appears to best correct mandibular deformity. A maxillomandibular deformity requires simultaneous maxillomandibular distraction. However, a metanalysis is still awaited for effectiveness of DO in TMJ ankylosis.

A systematic review was performed to assess the clinical outcomes of the reconstructive methods using autogenous grafts for the management of temporomandibular joint (TMJ) ankylosis A comprehensive electronic and manual search of the literature without date or language restriction was performed in January 2021 to identify randomized controlled trials, prospective, and retrospective studies with the aim of comparing the various surgical modalities for TMJ ankylosis. Twenty-six publications were included: prospective (n ​= ​17), retrospective (n ​= ​7), randomised control trial (n ​= ​1) and ambispective study (n ​= ​1). Costochondral graft was the most common graft used followed by Coronoid process graft. Meta-analysis was not possible as most of studies were non-controlled in nature. Based on the available data, there was a strong evidence that autogenous grafts especially Costochondral grafts and coronoid grafts have remained one of the most favoured methods of reconstruction. Prospective and randomized control studies are recommended for the best stratification for the use of autogenous grafts for the management of TMJ ankylosis.

Introduction: Finite element analysis (FEA) is a method to mimic the biomechanical behaviour of an object under various loading scenarios, and may be used during virtual planning of the TMJ prosthesis. Here we present an interesting case report where FEA was done to biomechanically evaluate patient specific total joint replacement prosthesis for bilateral TMJ replacement. Case report: A 22 year old young girl visited our outpatient clinic with a chief complaint of retruded chin and limited mouth opening for the last 15 years. After clinical and radiographic examination, her corrective surgery was virtually planned on Mimics software. The Implants were studied under simulated loading scenarios in ANSYS to understand the structural integrity of the implant for different loading conditions. Results: Maximum Von-Mises Stress on Condylar component is 151.9 MPa and Maximum Von-Mises Stress on Fossa component is 0.377 MPa. The minimum safety factor of the fossa component was about 15, which is safe enough to complete 100 million cycles. The maximum von-mises stress were detected at the screw holes in the condylar components of the implant. The screw holes were therefore the areas prone to highest chance of failure in the design. Conclusion: We conclude that FEA based biomechanical analysis is important prerequisite during customized reconstruction of TMJ. In today's scenario of patient specific TMJ reconstruction, FEA based designing and planning of stress distribution along the bone and calculation of maximum strain in the prosthesis, further aids in the proper designing of this implant and enhances the post-operative clinical results.

Background: Temporomandibular joint ankylosis is a distressing condition which leads to significant functional debility and facial blemish. It can be surgically managed with gap or interposition arthroplasty, with an objective to restore joint function and prevent re-ankylosis. Sometimes TMJ ankylosis can present with atypical presentations like skull base ankylosis. The main aim of this surgery is to successfully treat such conditions efficiently without any possible complications. However, surgical procedures for such atypical presentations in this disease are rarely reported. Case summary: Here we report a 27 year old male with Left TMJ ankylosis involving the skull base. The patient presented with reduced mouth opening with a previous history of trauma. For treatment we performed a surgery by doing osteoarthrectomy with interpositional arthroplasty of left TMJ using piezosurgery. To our knowledge this is the only TMJ ankylosis case with involvement of bones of the skull base treated with piezosurgery. Intraoperatively we achieved a mouth opening of 30 mm, and postoperatively after 15 days mouth opening up to 30 mm was achived with physiotherapy. Conclusion: Some times TMJ ankylosis can present with atypical presentations in which bones of the skull base are involved. These are very rare and could be termed as ‘skull base ankylosis’. Such cases can be surgically challenging and some surgical treatment modalities like Computer Assisted Surgery (CAS), 3D Navigation and Piezo-electric surgery could be beneficial in avoiding complications and facilitating efficient treatment.

Objective: Temporomandibular joint ankylosis (TMJa) is a distressing condition, but can be surgically managed by gap or interpositional arthroplasty, with an aim to restore joint function and prevent re-ankylosis. The aim of this paper is to compare two interposition materials used in management of TMJ ankylosis. Methods: 15 patients with TMJa were randomly allocated to two groups: group A (n = 6), interposition material used was medical-grade silicon elastomer, and group B (n = 9) where the interposition material used was temporalis fascia. Patients were followed up at regular intervals of 1 and 2 weeks, 1 month, 3 months, and 6 months and were assessed on following parameters: pain by VAS Scale, maximal mouth opening (MMO), implant rejection, and recurrence. Results: The results showed a loss of 4.6% and 7.9% in maximal interincisal mouth opening at 3rd and 6th months in Group A while Group B had a mean loss of 9% and 10% at 3rd and 6th months respectively without any significant difference. None of our cases showed recurrence or implant rejection. Conclusion: We conclude that silicone is comparable to temporalis fascia in terms of stability, surgical ease, and adaptability. It not only restores the function of mandible and ensures good maximum interincisal opening but also maintains the vertical ramal height. Also, it requires less operating time and is easy to handle but is not economical. It might be an effective way to restore function and prevent re-ankylosis.

Management of issues following condylar fracture is dependent on the effect on joint function and pain and an assessment of the degree of deformity. The following article aims to guide the reader in the assessment of these issues and the preservation of as much as is normal as possible. "First do no harm" is a phrase coined from the writings of Hippocrates, the Greek philosopher and physician. The cases described illustrate examples of where other clinicians have advised joint replacement, but where the author has used orthognathic or less invasive techniques to preserve existing tissues and joint function and to restore facial balance. They serve as a reminder that the complete TMJ surgeon needs a good orthognathic knowledge and expertise., (© 2022 Published by Elsevier B.V. on behalf of Craniofacial Research Foundation.)

Introduction: TMJ ankylosis (TMJa) management by arthroplasty alone fails to address the deformity and the compromised airway. Distraction osteogenesis (DO) can offer a pragmatic solution to TMJa. The aim of the study was to generate evidence towards the role of DO in TMJa, evaluate its efficiency and develop an algorithm for use of DO in TMJa., Material and Methods: The research question was formulated using the PICOS statement for reporting guidelines in systematic reviews, where the efficiency of DO was evaluated in terms of mouth opening, correction of facial deformity and asymmetry, airway correction, and its long term effects., Results: 1130 articles reported DO as a treatment modality for TMJ ankylosis, of which 32 prospective studies, 16 retrospective and 2 RCTs were included in the study. DO was used for mandibular distraction in 45 studies and for simultaneous maxillamandibular distraction in only five studies. An algorithm for use of DO in TMJa was developed., Conclusion: Although DO has proven its application in TMJ ankylosis cases, its best use is for correction of obstructive sleep apnoea. Relapse causing loss of posterior ramal height is a concern after transport DO. Prearthroplastic DO appears to best correct mandibular deformity. A maxillomandibular deformity requires simultaneous maxillomandibular distraction. However, a metanalysis is still awaited for effectiveness of DO in TMJ ankylosis., Competing Interests: No potential conflicts of interest were declared by any of the authors., (© 2021 Craniofacial Research Foundation. Published by Elsevier B.V. All rights reserved.)

A systematic review was performed to assess the clinical outcomes of the reconstructive methods using autogenous grafts for the management of temporomandibular joint (TMJ) ankylosis A comprehensive electronic and manual search of the literature without date or language restriction was performed in January 2021 to identify randomized controlled trials, prospective, and retrospective studies with the aim of comparing the various surgical modalities for TMJ ankylosis. Twenty-six publications were included: prospective (n ​= ​17), retrospective (n ​= ​7), randomised control trial (n ​= ​1) and ambispective study (n ​= ​1). Costochondral graft was the most common graft used followed by Coronoid process graft. Meta-analysis was not possible as most of studies were non-controlled in nature. Based on the available data, there was a strong evidence that autogenous grafts especially Costochondral grafts and coronoid grafts have remained one of the most favoured methods of reconstruction. Prospective and randomized control studies are recommended for the best stratification for the use of autogenous grafts for the management of TMJ ankylosis., Competing Interests: There are no conflicts of interest., (© 2021 Craniofacial Research Foundation. Published by Elsevier B.V. All rights reserved.)

Introduction: Finite element analysis (FEA) is a method to mimic the biomechanical behaviour of an object under various loading scenarios, and may be used during virtual planning of the TMJ prosthesis. Here we present an interesting case report where FEA was done to biomechanically evaluate patient specific total joint replacement prosthesis for bilateral TMJ replacement., Case Report: A 22 year old young girl visited our outpatient clinic with a chief complaint of retruded chin and limited mouth opening for the last 15 years. After clinical and radiographic examination, her corrective surgery was virtually planned on Mimics software. The Implants were studied under simulated loading scenarios in ANSYS to understand the structural integrity of the implant for different loading conditions., Results: Maximum Von-Mises Stress on Condylar component is 151.9 MPa and Maximum Von-Mises Stress on Fossa component is 0.377 MPa. The minimum safety factor of the fossa component was about 15, which is safe enough to complete 100 million cycles. The maximum von-mises stress were detected at the screw holes in the condylar components of the implant. The screw holes were therefore the areas prone to highest chance of failure in the design., Conclusion: We conclude that FEA based biomechanical analysis is important prerequisite during customized reconstruction of TMJ. In today's scenario of patient specific TMJ reconstruction, FEA based designing and planning of stress distribution along the bone and calculation of maximum strain in the prosthesis, further aids in the proper designing of this implant and enhances the post-operative clinical results., Competing Interests: None., (© 2020 Craniofacial Research Foundation. Published by Elsevier B.V. All rights reserved.)

Background: Temporomandibular joint ankylosis is a distressing condition which leads to significant functional debility and facial blemish. It can be surgically managed with gap or interposition arthroplasty, with an objective to restore joint function and prevent re-ankylosis. Sometimes TMJ ankylosis can present with atypical presentations like skull base ankylosis. The main aim of this surgery is to successfully treat such conditions efficiently without any possible complications. However, surgical procedures for such atypical presentations in this disease are rarely reported., Case Summary: Here we report a 27 year old male with Left TMJ ankylosis involving the skull base. The patient presented with reduced mouth opening with a previous history of trauma. For treatment we performed a surgery by doing osteoarthrectomy with interpositional arthroplasty of left TMJ using piezosurgery. To our knowledge this is the only TMJ ankylosis case with involvement of bones of the skull base treated with piezosurgery. Intraoperatively we achieved a mouth opening of 30 mm, and postoperatively after 15 days mouth opening up to 30 mm was achived with physiotherapy., Conclusion: Some times TMJ ankylosis can present with atypical presentations in which bones of the skull base are involved. These are very rare and could be termed as 'skull base ankylosis'. Such cases can be surgically challenging and some surgical treatment modalities like Computer Assisted Surgery (CAS), 3D Navigation and Piezo-electric surgery could be beneficial in avoiding complications and facilitating efficient treatment.

Objective: Temporomandibular joint ankylosis (TMJa) is a distressing condition, but can be surgically managed by gap or interpositional arthroplasty, with an aim to restore joint function and prevent re-ankylosis. The aim of this paper is to compare two interposition materials used in management of TMJ ankylosis., Methods: 15 patients with TMJa were randomly allocated to two groups: group A (n = 6), interposition material used was medical-grade silicon elastomer, and group B (n = 9) where the interposition material used was temporalis fascia. Patients were followed up at regular intervals of 1 and 2 weeks, 1 month, 3 months, and 6 months and were assessed on following parameters: pain by VAS Scale, maximal mouth opening (MMO), implant rejection, and recurrence., Results: The results showed a loss of 4.6% and 7.9% in maximal interincisal mouth opening at 3rd and 6th months in Group A while Group B had a mean loss of 9% and 10% at 3rd and 6th months respectively without any significant difference. None of our cases showed recurrence or implant rejection., Conclusion: We conclude that silicone is comparable to temporalis fascia in terms of stability, surgical ease, and adaptability. It not only restores the function of mandible and ensures good maximum interincisal opening but also maintains the vertical ramal height. Also, it requires less operating time and is easy to handle but is not economical. It might be an effective way to restore function and prevent re-ankylosis.