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Complex functional issues arising from temporomandibular joint (TMJ) ankylosis are associated with abnormal mandibular growth secondary to the condylar-glenoid fossa and its surrounding structures. These include severe limited mouth opening, micrognathia, mandibular asymmetry, and obstructive sleep apnoea (OSA), which necessitate effective treatment to allow optimum functional rehabilitation. This article aims to present a comprehensive systematic review of the surgical strategy for patients who present with a triad of TMJ ankylosis, micrognathia and OSA via a literature search of PubMed, Google Scholar, and Scopus following PRISMA guidelines. The outcomes of interest were difference in maximum mouth opening, incidence of reankylosis, amount of mandibular advancement, posterior airway space, preoperative and postoperative apnoea/hypopnoea index, and arterial oxygen saturation, as well as changes in other cephalometric or polysomnographic variables. Thirty four studies involving 360 patients were included. Surgical interventions included distraction osteogenesis (DO), release of TMJ ankylosis and mandibular advancement, simultaneous arthroplasty and DO, pre-athroplasty DO, and post-arthroplasty DO. Most studies reported functional post-intervention mouth opening, with reankylosis reported in four. Mandibular advancement was between 6 mm and 34 mm. All studies reported improvement in the various polysomnographic variables measured. In conclusion, the systematic review was conducted based on a low level of literature evidence. Even though various surgical strategies were reported, effective case-specific management of TMJ ankylosis with micrognathia and OSA requires comprehensive assessment and careful consideration of surgical options that promote mandibular advancement and airway improvement. [ABSTRACT FROM AUTHOR]

Ankylosis of the temporomandibular joint (TMJ) is associated with restricted mandibular movements, with deviation to the affected side. The management of TMJ ankylosis involves surgery to mitigate the effects of ankylosis, and adjunctive appliance therapy to supplement the results achieved through surgery. Several appliances have been used to help maintain jaw mobility postsurgery, but have been rarely documented in the literature. Our systematic review aimed to examine the clinical outcomes of various appliances for TMJ ankylosis management. A comprehensive electronic search of the literature was performed in July 2022 to identify eligible articles that had tested the use of orthodontic or physiotherapy appliances for the management of TMJ ankylosis. In total, 13 publications were included in the narrative synthesis. Both generic and custom-made appliances were used, with overall findings suggesting that using these appliances improved mouth opening and reduced chances of re-ankylosis. In this review no universally accepted appliance was found to be utilized, and the criteria used for appliance selection were unclear. The field of research in developing appliances for the treatment of TMJ ankylosis is open to advancement, and this review will help guide future research in this area. [ABSTRACT FROM AUTHOR]

Purpose: In the digital era, the internet is the go-to source of information, and patients often seek insights on medical conditions like TMJ ankylosis. YouTube, a popular platform, is widely used for this purpose. However, YouTube's lack of regulation means it can host unreliable content. Hence, the primary objective of this study is to assess the scientific quality of YouTube videos concerning TMJ ankylosis. Materials and methods: This study analyzed 59 TMJ ankylosis-related videos. Two Oral and Maxillofacial Surgery specialists assessed these videos. Data on the video source, duration, upload date, the time elapsed since upload, total views, likes, dislikes and comments, Interaction index, and viewing rate were collected and analyzed. Video quality was assessed using the Global Quality Scale (GQS) and the Quality Criteria for Consumer Health Information (DISCERN), comparing health professionals and non-health professionals. Results: Health professional's videos were better in terms of GQS 3.21 ± 0.94 and DISCERN score 3.03 ± 0.75 as compared to the non-health professional videos GQS 3.0 ± 1.04, and DISCERN 2.81 ± 1.13. Health professional group videos had more reliability and better quality than the non-health professional group (p < 0.01). Conclusion: YouTube should not be relied on as a trustworthy source for high-quality and reliable information regarding TMJ ankylosis videos. Healthcare professionals must be prepared to address any ambiguous or misleading information and to prioritize building trustworthy relationships with patients through accurate diagnostic and therapeutic processes. [ABSTRACT FROM AUTHOR]

This prospective cohort study examined the changes in airway area and soft tissue parameters following interpositional arthroplasty for temporomandibular joint (TMJ) ankylosis. Ten patients with TMJ ankylosis underwent surgery, and preoperative and postoperative skeletal and soft tissue measurements were obtained. A significant rise in soft tissue parameters was observed following surgery, although only minor changes in skeletal parameters were seen. The nasoropharyngeal area, oral area, soft palate area, and tongue area were examined. After the surgery, increases in values were observed in the nasoropharyngeal area (from 3482.4 mm2 to 3618.7 mm2), the oral area (from 2731.8 mm2 to 2840.8 mm2), the soft palate area (from 204.9 mm2 to 217.3 mm2), and the tongue area (from 2577.5 mm2 to 2600.8 mm2). These findings suggest that interpositional arthroplasty can improve airway area and soft tissue dimensions, affecting the stomatognathic system's aesthetic and functional aspects. Further research is needed to validate these results and assess long-term stability. [ABSTRACT FROM AUTHOR]

Background: Temporomandibular joint (TMJ) ankylosis frequently results in mandibular asymmetry, which impairs an affected person’s ability to function and look good. Because of the intricacy of TMJ ankylosis and the variety of surgical procedures available, correcting mandibular asymmetry surgically can be difficult. Methods: Patients with mandibular asymmetry and TMJ ankylosis who had surgery at a tertiary care facility between certain periods were the subject of a retrospective investigation. Medical records were used to gather information on patient demographics, pre-operative imaging, surgical methods, and post-operative results. Surgical methods included condylectomy with or without reconstruction, joint reconstruction with or without orthognathic surgery, and unilateral or bilateral mandibular distraction osteogenesis (MDO). Occlusion, patient-reported results, and facial symmetry made up the evaluation criteria. Findings: The study had a total of 50 patients, with different surgical method distributions. Comparing unilateral and bilateral MDO to condylectomy and joint reconstruction, notable gains in face symmetry and occlusion were seen. The largest complication rate was seen with condylectomy, mostly from recurrence and device-related issues, albeit the rates of other procedures varied as well. Conclusion: In conclusion, customized treatment planning is necessary for the correction of mandibular asymmetry in individuals with TMJ ankylosis. Although mandibular distraction osteogenesis produces better results for occlusion and facial symmetry, it is crucial to carefully weigh the risks involved. While still feasible treatments, condylectomy and joint reconstruction require strict monitoring for any consequences. In order to enhance patient care in this difficult patient group, future research should concentrate on improving treatment procedures and long-term results.

Restricted mouth opening is a challenging airway in pediatric patients with temperomandibular joint (TMJ) ankylosis. The fiber-optic bronchoscopic nasotracheal intubation technique continues to be the gold standard for difficult airway, among the techniques available such as submandibular intubation, retrograde intubation, and tracheostomy. However, awake fiber-optic bronchoscopy (FOB) is difficult to achieve in pediatric patients. Prior planning of the anesthetic method and effective collaboration with the surgeon are crucial for excellent outcomes in such challenging airway cases. We present a successful awake fiber-optic bronchoscopy with high-flow nasal oxygen (HFNO), airway blocks, and deep sedation in the case of bilateral TMJ ankylosis of a pediatric age group with reduced mouth opening. We conclude that awake intubation using HFNO and airway blocks helps to achieve oxygenation and ease of intubation in difficult airway management.

Restricted mouth opening is a challenging airway in pediatric patients with temperomandibular joint (TMJ) ankylosis. The fiber-optic bronchoscopic nasotracheal intubation technique continues to be the gold standard for difficult airway, among the techniques available such as submandibular intubation, retrograde intubation, and tracheostomy. However, awake fiber-optic bronchoscopy (FOB) is difficult to achieve in pediatric patients. Prior planning of the anesthetic method and effective collaboration with the surgeon are crucial for excellent outcomes in such challenging airway cases. We present a successful awake fiber-optic bronchoscopy with high-flow nasal oxygen (HFNO), airway blocks, and deep sedation in the case of bilateral TMJ ankylosis of a pediatric age group with reduced mouth opening. We conclude that awake intubation using HFNO and airway blocks helps to achieve oxygenation and ease of intubation in difficult airway management. [ABSTRACT FROM AUTHOR]

Purpose: Temporomandibular joint ankylosis (TMJA) in children is associated with retrognathia, reduction in pharyngeal airway volume (PAV), and obstructive sleep apnea (OSA). Distraction-osteogenesis (DO) is the proven method in the management of OSA. There is paucity in literature about the effect of distraction vector on PAV. It can be expected that an oblique vector would improve PAV and relieve OSA. Thus, the study was designed to explore the feasibility, advantages, and disadvantages of this modified technique for managing TMJA and OSA simultaneously. Materials and method: The investigators designed a prospective study on patients of TMJA with retrognathia. Ethical approval was obtained (IECPG-547/14.11.2018). In all patients, simultaneous ankylosis release and mandibular distraction were performed. Primary outcome variables were improvement in 3-dimensional (3D) PAV and maximal interincisal opening (MIO). Secondary outcome variables were changed mandibular length, distraction relapse, and re-ankylosis. Paired t-test and multivariate ANOVA were used to assess all the parameters. Result: The study included 13 joints in 8 patients of TMJA with retrognathia (2 unilateral and 6 bilateral ankylosis) with mean age of 14.25 ± 7.37 years. Mean distraction performed was 19 ± 4.0 mm. There was a statistically significant improvement of PAV by 225% (p = 0.002), a reduction in Epworth's scale (p = 0.017), an increase in MIO (p = 0.001), and an increase in mandibular length. Three patients had re-ankylosis at the 25-month follow-up. Conclusion: The results of the present study conclude that modification of distraction vector improves 3D PAV and MIO in TMJA patients, with the added advantage of a reduction in overall treatment time and improved patient compliance. [ABSTRACT FROM AUTHOR]

Temporomandibular joint (TMJ) ankylosis leads to mandibular micrognathia that severely collapses the upper airway causing obstructive sleep apnoea (OSA), resulting in deterioration and compromise in the quality of life (QoL) of patients. In this study, we aimed to calculate airway volume changes, apnoea-hypopnoea index (AHI), and improvement in quality of life before and after distraction osteogenesis (DO). Fourteen Patients with OSA secondary to TMJ ankylosis at a mean (SD) age of 17.5 (5.43) years were enrolled in this prospective study. Multivector mandibular distractors were used in all patients following the standard Ilizarov distraction protocol with a mean (SD) anteroposterior distraction of 16.21 (4.37) mm and a consolidation period of 116.92 (14.35) days. The patients were followed up for six months. A polysomnography test (PSG) was done to quantify AHI and a low-dose computed tomographic scan was done to calculate airway volume using Dolphin medical imaging software pre and post-DO. The QoL of the patients was calculated using the OSA-18 questionnaire. Results analysis depicted that the mean (SD) preoperative AHI was 51.44 (37.99)/h which was improved to 9.57 (9.74)/h (p = 0.001) after DO. Airway volume was calculated on Dolphin software before and after DO showed a significant improvement in airway volume by 121.12% (98.30)%. Similarly, the OSA-18 questionnaire showed significant improvement in QoL from severe to normal. This study suggested that DO increases the corpus length of the mandible, leading to an increment in airway volume, which improves the QoL. [ABSTRACT FROM AUTHOR]

The aim of this study is to present a sequential strategy of soft-tissue, non-osteogenic distraction with a novel device, followed by microvascular bony reconstruction for severe cases of mandibular hypoplasia. The case of a 21-year-old woman with Goldenhar syndrome is presented, whose mandible remained severely hypoplastic despite previous attempts at distraction and was not suitable for further osteogenic distraction. Soft tissue deficiency and pin track scarring prevented free fibular transfers. A personalized distractor, anchored to the cranium and the mandibular symphysis, was designed to expand the soft tissues while allowing for physiological temporomandibular joint (TMJ) movement without compression forces. Internal distractors were placed along the osteotomies to prevent condylar luxation. After completion of the soft tissue distraction, the native mandible was resected except for the condyles and reconstructed with two free fibula flaps. This report represents the proof of concept of a sequential approach to severe lower face soft-tissue and bone deficiency, which preserves TMJ function and avoids the transfer of poorly matched skin to the face. [ABSTRACT FROM AUTHOR]

Introduction: Skeletal abnormalities in patients with post-traumatic facial deformities can generally be corrected with current craniomaxillofacial techniques. Delay in operative management secondary to associated life-threatening injuries, failure to appreciate the magnitude of the initial facial injury, inadequate operative treatment and operative complications contribute to their occurrence. Systematic evaluation of the midface, including the position of the globes, orbits, zygomatic (facial) width and occlusion, is of paramount importance. Some contour deficiencies can be camouflaged by relatively simple procedures, whereas some deformities may require osteotomies and repositioning of the displaced segments. Staged procedures need to be planned carefully so that previously diagnosed deformities are not concealed and new deformities are not created. The general goals of reconstruction are (i) to restore normal and anatomic bone alignment, (ii) to re-establish the underlying skeletal support prior to addressing soft tissue abnormalities and (iii) to replace missing tissue with like tissues. Conclusion: Restoring the normal bony architecture should be the initial consideration unless the quantity or quality of the soft tissue envelope is inadequate to protect the osseous reconstruction. The purpose of this study is to evaluate post-traumatic facial deformities and simulation and organization of all the treatment modalities in a sequential manner. [ABSTRACT FROM AUTHOR]

Tapia syndrome is an extremely rare condition involving simultaneous paralysis of cranial nerves X (recurrent laryngeal branch) and XII. It is mostly believed to occur as a neuropraxic complication of intraoperative airway management. We present a unique case of a 17-year-old female with dysphonia, dysphagia, and deviation of tongue to the right side following temporomandibular joint gap arthroplasty for release of left TMJ ankylosis. A clinical diagnosis of Tapia's syndrome was made on exclusion of surgical or intracranial etiology and conservative management was performed. The aim of this study is to discuss the possible etiology, symptoms, and treatment of this disease along with a review of seven cases of Tapia syndrome associated with maxillofacial surgeries. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the efficacy of simultaneous TMJ ankylosis (TMJA) release with uniplanar mandibular distraction in the management of facial deformity, improvement in function and obstructive sleep apnoea in growing patients. Material and Methods: Ten patients in the age group of 5–15 years with unilateral/bilateral TMJA and mild to moderate OSA and short body length but ramus height within normal limits were treated with simultaneous ankylosis release and uniplanar mandibular distraction osteogenesis. Clinical, radiographic, and OSA parameters were evaluated and followed up for 1 year. Results: Average mandibular body length increased by 16.6 mm, mouth opening by 26.9 mm, SNB angle by 9.53°, pharyngeal airway space by 6.29 mm, chin discrepancy corrected by 5.05 mm, apnoea–Hypopnoea index decreased by 15.9, N┴Pog by 12.27 mm, oxygen saturation (Spo2) by 4.1%, and oxygen desaturation index by 17.89%. All clinical, radiographic, and OSA parameters improved and were statistically significant except for mandibular plane angle and with minimal complications. Conclusion: Simultaneous TMJA release with uniplanar mandibular Distraction osteogenesis may be recommended as the treatment of choice in growing patients with mild to moderate OSA and facial deformity, as it causes simultaneous correction of micrognathia, facial asymmetry, OSA and prevents the need for an additional surgery. [ABSTRACT FROM AUTHOR]

Abstract Background There are several indications for partial or total replacement of the temporomandibular joint (TMJ), including neoplasms and severe bone resorptions. In this regard, several techniques have been suggested to increase the functionality and longevity of these prosthetic devices. This case report describes the treatment of a TMJ ankylosis patient with the Puricelli biconvex arthroplasty (ABiP) technique, with a long-term follow-up. Case presentation In 1978, a 33-year-old male polytraumatised patient developed painful symptoms in the right preauricular region, associated with restricted movement of the ipsilateral TMJ. Due to subcondylar fracture, an elastic maxillomandibular immobilisation (EMMI) was applied. Subsequently, the patient was referred for treatment when limitations of the interincisal opening (10 mm) and the presence of spontaneous pain that increased on palpation were confirmed. Imaging exams confirmed the fracture, with anteromedial displacement and bony ankylosis of the joint. Exeresis of the compromised tissues and their replacement through ABiP was indicated. The method uses conservative access (i.e., preauricular incision), partial resection of the ankylosed mass, and tissue replacement using two poly(methyl methacrylate) components, with minimal and stable contact between the convex surfaces. At the end of the procedure, joint stability and dental occlusion were tested. The patient showed significant improvement at the postoperative 6-month follow-up, with no pain and increased mouth opening range (30 mm). At the 43-year follow-up, no joint noises, pain or movement restrictions were reported (mouth opening of 36 mm). Imaging exams did not indicate tissue degeneration and showed the integrity of prosthetic components. Conclusions The present case report indicates that ABiP enables joint movements of the TMJ, allowing the remission of signs and symptoms over more than 40 years of follow-up. These data suggest that this technique is a simple and effective alternative when there is an indication for TMJ reconstruction in adult patients with 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.

Background: Temporomandibular joint (TMJ) ankylosis isa condition associated with limited to zero mouth opening. In addition to facial asymmetry, malocclusion, anaemia and malnutrition, airway obstruction may be present. All these changes make, not only intubation, but ventilation also difficult. Aim: the aim our study was the anaesthetic management of unilateral temporomandibular joint ankylosis with partial mouth opening. Method: In this article we want to report anaesthetic management of 20 patients having unilateral TMJ ankylosis with partial mouth opening. In all patients' mouth opening was from 8mm to 10mm. Observation: In 80% patients we could intubate by oral intubation technique while remaining 20% patients were intubated by other means. Conclusion: Patients with partial mouth opening could be intubated orally in maximum cases, After Induction: with inj:Propofol 2mg/kg and inj: succinylcholine 2 mg/kg, we could manage oral intubation successfully. [ABSTRACT FROM AUTHOR]

Autogenous methods for reconstruction arthroplasty (RA) for the surgical management of the temporomandibular joint (TMJ) have been extensively reported. The present review was aimed to systematically review and pool data on clinical outcomes of autogenous grafts for RA in subjects with TMJ ankylosis. Major electronic databases and prominent subject-specific journals were searched up to December 2020. Randomised controlled trials (RCT), cohort studies, and retrospective studies reporting outcomes of autogenous grafts for RA in TMJ ankylosis were included. A total of 35 studies with 700 subjects was included. The most commonly employed grafts were costochondral grafts (CCG) and coronoid process grafts. Postoperative change in maximum incisor opening (MIO) was comparable amongst all grafts and was in the clinically acceptable range (27.21–31.38 mm). The recurrence rate was comparable for all grafts and was ≈ 8% except for coronoid grafts, where the recurrence rate was 2.98%. Growth assessment for CCG revealed that 55.89%, 30.89%, and 13.24% of subjects depicted optimal growth, overgrowth, and undergrowth, respectively. Within the limitations of the present review, the recurrence rate for all grafts was comparable except for coronoid graft, which depicted least recurrence rate and resultant postoperative change in MIO was in the clinically acceptable range. [ABSTRACT FROM AUTHOR]

Congenital syngnathia is a very rare condition of unknown etiology with multiple clinical manifestations due to different combinations of bony or soft tissue adhesions between the mandible and maxilla. It shares possible association with other congenital anomalies in the head and neck region, or with other syndromes. The aims of the present work were: (1) to perform a literature review on bony syngnathia in order to obtain a general framework on epidemiology and management protocol; (2) to describe a case of a two-year-old boy with a left unilateral bony fusion treated with a distraction protocol of three months. Original articles were searched through PubMed, Cochrane Central database and Embase with a cut-off date of June 2022. In total, 94 articles were identified through database searching. After 39 exclusions, 55 articles were included in the review process. Eighty-seven cases of bony syngnathia have been reported from 1936 to 2022, and different classifications have been suggested in terms of location, extension, functional outcomes and management protocol. Complications may range from feeding difficulty to aspiration pneumonia and respiratory arrest. Early surgery is generally required to release the ankylosis and to establish good mandible function. [ABSTRACT FROM AUTHOR]

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.

Aims: The current manuscript explores the viability of reverse sagittal split osteotomy technique for correction of ankylotic cases with post gap arthroplasty mandibular retrognathia to achieve socially acceptable esthetic results. Method: Reverse sagittal split osteotomy which was introduced by Collins et al in 1983 was performed with certain modifications on two cases to correct mandibular hypoplasia in post gap arthroplasty cases. The paper also highlights intraoral as well as extraoral approach for performing the osteotomy along with better management of bad split under direct vision Result: It was observed that the reverse sagittal split technique for advancement of mandible in cases of tmj ankylosis-induced dentofacial deformity provided better proximal control, reduced chances of bad split, greater range of advancement (11–14 mm) with esthetically acceptable results. The osteotomy cuts on lateral surface of mandible make the procedure effectively easier and quicker with better control over proximal segment and management under direct vision. Conclusion: When Distraction Osteogenesis and conventional orthognathic is not a choice in management of dentofacial deformity of post-release ankylosis cases due to the poor proximal control and concern over bad split, reverse sagittal split can be an appropriate choice to manage these deformities without any donor site morbidity. [ABSTRACT FROM AUTHOR]

Background: The purpose of this single-centre prospective clinical study was to evaluate the correction of severe facial deformity and Obstructive sleep apnoea hypopnoea syndrome (OSAHS) in 22 patients aged from 9 to 42 years (mean 20.09) of bilateral Temporomandibular joint ankylosis. Materials and Methodology: Patients underwent multisegment distraction using external bilateral bidirectional distractors. Facial deformity was evaluated clinically in terms of mouth opening and neck chin angle and cephalometrically in terms of corpus length (gonion-pogonion), ramal height (articulare-gonion), chin deficiency (N perpendicular to Pog and SNB). OSAHS was evaluated through Epworth sleepiness scale, Berlin's questionnaire, pharyngeal airway space, apnoeic hypoapnoeic index, oxygen desaturation index, average arterial oxygen saturation and minimal fall in O2 saturation. Patients were followed up for a period of 13–74 months (mean 28.68). Results: Statistically highly significant results were obtained in all parameters. Complications encountered were pin infection (13.63%), loosening of pins (4.5%), wound dehiscence (9.09%), tooth fracture (4.5%) and parotid fistula (9.09%). Intermediate segment necrosis and vector loss were not observed. Conclusion: This study is a large case series using two corticotomy cuts for external bilateral bidirectional distracters with concomitant neo callous moulding in patients both pre- and post-ankylosis release. It is extremely efficient in correcting mandibular corpal and ramal deficiency as well as improving OSAHS. [ABSTRACT FROM AUTHOR]

Background: There are several indications for partial or total replacement of the temporomandibular joint (TMJ), including neoplasms and severe bone resorptions. In this regard, several techniques have been suggested to increase the functionality and longevity of these prosthetic devices. This case report describes the treatment of a TMJ ankylosis patient with the Puricelli biconvex arthroplasty (ABiP) technique, with a long-term follow-up. Case presentation: In 1978, a 33-year-old male polytraumatised patient developed painful symptoms in the right preauricular region, associated with restricted movement of the ipsilateral TMJ. Due to subcondylar fracture, an elastic maxillomandibular immobilisation (EMMI) was applied. Subsequently, the patient was referred for treatment when limitations of the interincisal opening (10 mm) and the presence of spontaneous pain that increased on palpation were confirmed. Imaging exams confirmed the fracture, with anteromedial displacement and bony ankylosis of the joint. Exeresis of the compromised tissues and their replacement through ABiP was indicated. The method uses conservative access (i.e., preauricular incision), partial resection of the ankylosed mass, and tissue replacement using two poly(methyl methacrylate) components, with minimal and stable contact between the convex surfaces. At the end of the procedure, joint stability and dental occlusion were tested. The patient showed significant improvement at the postoperative 6-month follow-up, with no pain and increased mouth opening range (30 mm). At the 43-year follow-up, no joint noises, pain or movement restrictions were reported (mouth opening of 36 mm). Imaging exams did not indicate tissue degeneration and showed the integrity of prosthetic components. Conclusions: The present case report indicates that ABiP enables joint movements of the TMJ, allowing the remission of signs and symptoms over more than 40 years of follow-up. These data suggest that this technique is a simple and effective alternative when there is an indication for TMJ reconstruction in adult patients with ankylosis. [ABSTRACT FROM AUTHOR]

This systematic review was planned to assess the clinical outcomes of transport distraction osteogenesis (TDO) compared with autogenous grafts for reconstruction of the ramus condyle unit (RCU). We searched Medline, Embase, Cochrane Library, Clinicaltrial.gov, and the references of included trials. The primary outcome was maximal incisal opening (MIO). Of the 148 studies retrieved, five were included (TDO = 49, autogenous grafts =123). The mean difference in MIO between TDO and autogenous graft RCU reconstruction, based on the random-effects model was 1.28 mm (95% CI 0.167 to 2.403) in favour of TDO. Re-ankyosis was observed in four cases in the costochondral graft group and none in the TDO group. Reconstruction of the RCU using TDO is comparable to autogenous grafts after the release of TMJ ankylosis, though the evidence is weak considering the small number of trials, high risk of bias, and absence of long-term results. [ABSTRACT FROM AUTHOR]

Infiltrating lipomatosis is a rare benign condition causing diffuse fatty infiltration into the surrounding soft tissue and in rare cases causes hyperplasia of the adjacent bone. We report a case with clinical and radiological evidence of a 34-year-old female patient who reported a swelling in the left middle third of the face with exophytic temporomandibular joint (TMJ) ankylosis of the left side resulting in restricted mouth opening and facial asymmetry since 21 years. The number of cases reported in the literature is rare. Surgery is the treatment of choice. [ABSTRACT FROM AUTHOR]

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.

A gold-standard technique has yet to be found for the treatment of temporomandibular joint ankylosis (TMJa), particularly in patients with recurring ankylosis. A 58-year-old male patient, with a history of multiple TMJ surgeries and severe limitation of mouth opening (maximum interincisal distance [MID] was 10 mm). Computerised tomography (CT) imaging highlighted a bilateral type IV ankylosis. The surgical guides were manufactured using a 3D printing method after obtaining a proper design of the osteotomy lines. The positioning of the fossa and condyle components of the custom TMJ prosthesis was digitally performed. Osteotomies were carried out using surgical guides and TMJ prostheses were placed as per the virtual planning. A human amniotic mambrana is inserted between the two prosthetic components to avoid ranchylosis. The post-operative CT showed the correct positioning of the condylar prosthesis. MID after 10 days was 37 mm. Total joint reconstruction surgery using 3D virtual surgical planning may be an effective surgical option for achieving a precise surgical outcome and making use of a single-stage approach in cases of TMJa and the use of the amniotic membrane, thanks to its healing properties and reduction of pain perception, seems to improve the quality of the immediate post-operative period. [ABSTRACT FROM AUTHOR]

There is limited knowledge about masticatory function after the release of temporomandibular joint (TMJ) ankylosis. In this study, masticatory function was evaluated by measuring maximum voluntary bite force (MVBF) and chewing efficiency in 30 unilateral TMJ ankylosis patients who were treated with buccal fat pad (BFP) interpositional arthroplasty. Eighteen subjects over 12 years of age were included in study Group A and 12 subjects below 12 years of age in study Group B. Patients in the study groups had completed a minimum follow up of one year after surgery. Control groups C (over 12 years of age, n = 18) and D (under 12 years of age, n = 12) consisted of age, sex, and weight-matched normal subjects. The mean MVBF was measured between occluding molar teeth with a strain gauge transducer. Chewing efficiency was measured with two different coloured chewing gum strips. These were chewed for 5, 10, 20, 30, and 50 strokes. Compared with normal subjects, the study groups (A and B) could generate 64.7% (p = 0.004*) and 89.8% (p = 0.121) of MVBF, respectively. Overall chewing efficiency was 88.7% in Group A and 92.9% in Group B (p = 0.014* and p = 0.138, respectively) when compared with normal subjects. The study has shown that BFP interpositional arthroplasty effectively restores masticatory function. [ABSTRACT FROM AUTHOR]

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We are presenting a case report of anaesthetic management in a case of temporomandibular joint (TMJ) ankylosis with an intraprocedural finding of choanal atresia in a 17yr old male posted for elective lateral gap arthroplasty. Anticipated difficult airway in TMJ ankylosis patients has always made the surgeon to be cautious during airway management, adding on problem like choanal atresia made the intubation even more difficult. Hence, reporting the management of such difficulties with different approach, in which serial dilatation of nostrils using nasogastric tubes and nasal airway, then endotracheal tube was passed through one nostril and bronchoscope through other nostril. [ABSTRACT FROM AUTHOR]

Temporomandibular joint ankyloses (TMJA) may manifest in patients with several predisposing systemic conditions. A case of extraarticular TMJA is presented in a patient diagnosed with fibrodysplasia ossificans progressive (FOP) is presented. The features, diagnosis, and management of TMJA superimposed on this condition are presented through a qualitative systematic review of literature. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Temporomandibular joint ankylosis-associated deformity and dysfunction is a challenge to reconstruct. Alloplastic temporomandibular joints, both stock and custom-made, are used to replace the ankylotic mass with a functional joint. Still, the cost of these alloplastic joints is so expensive that it cannot be affordable to most of our population. Purpose: A primary objective of achieving at least 35 mm of mouth opening was planned. Secondarily we planned to achieve a functional occlusion with acceptable facial balance and symmetry. Method: Autologous TMJ reconstruction using vascularized second metatarsal joint transfer with concomitant orthognathic surgery. The surgery aims to achieve a significant functional rehabilitation with correction of maxillomandibular deformity in a single-stage surgery. Results: As a result of this, we present our initial experience to rehabilitate the patient with temporomandibular joint ankylosis both functionally and aesthetically by performing simultaneously joint replacement using the patient's own vascularized second metatarsal joint and concomitantly performing the orthognathic surgery. By this, we could holistically treat the patient with minimal cost and make them socially acceptable. Conclusion: We do not propose a 2nd metatarsal vascularized flap as a substitute for a custom-made total TMJ prosthesis. Still, we suggest a viable option in a selected set of patients where TMJ prosthesis cannot be afforded or has failed with a history of multiple surgeries in the same region. [ABSTRACT FROM AUTHOR]

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.

Abstract Temporomandibular joint ankyloses (TMJA) may manifest in patients with several predisposing systemic conditions. A case of extraarticular TMJA is presented in a patient diagnosed with fibrodysplasia ossificans progressive (FOP) is presented. The features, diagnosis, and management of TMJA superimposed on this condition are presented through a qualitative systematic review of literature.

Wound healing is nature's response to injury. It is a complex and dynamic process involving multiple biological systems aimed at restoring the integrity of damaged tissue. The temporomandibular joint (TMJ) is a critical anatomical structure that facilitates jaw movement and function. TMJ ankylosis is a pathological condition characterized by fusion of the mandibular condyle to the glenoid fossa resulting in severe restriction in mouth opening and significantly reduced mandibular movements. This condition affects the patient's quality of life by deteriorating major functions such as mastication, speech, oral hygiene, breathing, facial growth, and esthetics. Gap arthroplasty is the mainstay of treatment. There are various surgical approaches to TMJ such as Al-Kayat Bramley, Popowich's modification, Blair's inverted hockey stick, Dingman's, Thoma's, endaural, postauricular, and rhytidectomy incisions. Wound healing in the TMJ region poses unique challenges due to its complex anatomy and the high level of mechanical stress it endures. Following trauma to TMJ, hematomas are organized by fibrous granulation tissues and mesenchymal stem cells are recruited from adjacent bone by cytokines and chemokines such as bone morphogenetic proteins, transforming growth factor-beta and stromal cell-derived factor 1. These recruited mesenchymal cells differentiate into osteoprogenitors and osteoblasts to form new bone and fibroblasts to form a scar. In humans, scarring is the final outcome of the wound healing process, which has evolved to rapidly repair injuries. Scarring from injuries, surgeries, and burns places a significant burden on the healthcare system. Patients with major scars, especially children and adolescents, often experience long-term functional and psychological issues. This article aims to present a case of post-surgical hypertrophic scar in a patient after gap arthroplasty through Al-Kayat Bramley incision and the role of a multi-professional team to treat such wounds., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Cheruvathur et al.)

Background: Temporomandibular joint (TMJ) ankylosis frequently results in mandibular asymmetry, which impairs an affected person's ability to function and look good. Because of the intricacy of TMJ ankylosis and the variety of surgical procedures available, correcting mandibular asymmetry surgically can be difficult., Methods: Patients with mandibular asymmetry and TMJ ankylosis who had surgery at a tertiary care facility between certain periods were the subject of a retrospective investigation. Medical records were used to gather information on patient demographics, pre-operative imaging, surgical methods, and post-operative results. Surgical methods included condylectomy with or without reconstruction, joint reconstruction with or without orthognathic surgery, and unilateral or bilateral mandibular distraction osteogenesis (MDO). Occlusion, patient-reported results, and facial symmetry made up the evaluation criteria., Findings: The study had a total of 50 patients, with different surgical method distributions. Comparing unilateral and bilateral MDO to condylectomy and joint reconstruction, notable gains in face symmetry and occlusion were seen. The largest complication rate was seen with condylectomy, mostly from recurrence and device-related issues, albeit the rates of other procedures varied as well., Conclusion: In conclusion, customized treatment planning is necessary for the correction of mandibular asymmetry in individuals with TMJ ankylosis. Although mandibular distraction osteogenesis produces better results for occlusion and facial symmetry, it is crucial to carefully weigh the risks involved. While still feasible treatments, condylectomy and joint reconstruction require strict monitoring for any consequences. In order to enhance patient care in this difficult patient group, future research should concentrate on improving treatment procedures and long-term results., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Pharmacy and Bioallied Sciences.)

Temporomandibular joint (TMJ) ankylosis is a condition in which bony or fibrous adhesion of the anatomical joint components results in loss of function. This is particularly distressing and debilitating for patients who struggle to maintain good oral hygiene, which results in additional pain, oral disease, and ultimately, a poor aesthetic profile. A retrospective chart review was carried out to document the cases of three patients who attended a single centre for the management of ankylosis of the TMJ. Consent for chart review and use of photographs was gained from each one. Charts were obtained, records reviewed, and each of the cases written up for presentation in a case series. All three underwent arthroplasty of the TMJ and insertion of Matthews devices (two patients unilateral, one bilateral). All were followed up postoperatively. They experienced significant improvements in vertical mouth opening which have been maintained to the present. The Matthews device allows movement and physiotherapy postoperatively whilst maintaining the surgically created space. This prevents impingement on the tissues placed between the glenoid fossa and mandible, and appears to prevent relapse and further ankylosis. To our knowledge, few studies to date have documented the use of the Matthews device following interpositional arthroplasty of the TMJ. [ABSTRACT FROM AUTHOR]

Interpositional gap arthroplasty has established itself as the the standard surgical treatment of Temporomandibular joint (TMJ) ankylosis. The autogenous tissue has replaced the alloplastic and other xenografts materials owing to its bioavailability, easy uptake, and no additional cost. Commonly used autogenous tissue has been temporalis muscle and fascia, fascia lata, skin graft, auricular and costal cartilage, the masseter and/or medial pterygoid muscle. With the turn of the century, TMJ surgeons started using autogenous fat from the lower abdomen and today it has taken over as the most favored autogenous filler material in TMJ ankylosis surgery or total joint replacement (TMJ-TJR). The use of buccal fat pad (BFP) has increased in the last decade due to its local availability and pedicled nature. This paper will discuss various autogenous tissues used in interposition and bring forth the journey of the autogenous fat as the preferred interpositional material now and rest the case in its favor. [ABSTRACT FROM AUTHOR]

Aim: To compare treatment outcome of arthroplasty followed by distraction osteogenesis (AFD) and distraction osteogenesis followed by arthroplasty (DFA) in the management of mandibular deficiencies in temporomandibular joint (TMJ) ankylosis. Materials and methods: A total of 20 patients with TMJ Ankylosis were included in the study. Patients were randomly divided into two groups. Group 1 consisted of patients for whom arthroplasty was done prior to distraction osteogenesis (AFD) for the correction of deficient mandible. Group 2 included patients where distraction osteogenesis was performed prior to arthroplasty (DFA). The treatment outcome was assessed based on maximum interincisal distance, overjet, corpus length, ramus height, upper airway, lower airway, duration of the procedure and the complications for the treatment at the end of 3, 6 and 12 months. Results: After the treatment was ended, the patients of both groups had increase in mouth opening and appearance was improved remarkably. There was general increase in all the parameters in both the groups. But at the end of 12 months, airway and the ramus height were more stable and the control of the proximal segment was superior in DFA group. Open bite was noticed in 2 cases of AFD group which was treated by elastics. There required additional surgery for the removal of distractors in the AFD Group. Establishing the airway during the surgery was easier in AFD group. Conclusion: The study concludes that distraction followed by arthroplasty was a better procedure for the management of TMJ ankylosis owing to its stable results and less number of surgeries. [ABSTRACT FROM AUTHOR]

Radiotherapy at the temporomandibular joint (TMJ) area often results in trismus, however, post radiation ankylosis is extremely rare and has not been previously reported in literature. Radiation is known to impact the vasculature of bony structures leading to bone necrosis with certain risk factors including surgical intervention, even teeth extraction, that could lead to osteoradionecrosis. Accordingly, gap arthroplasty for such case seemed rather challenging. In this report, we introduce for the first time, a rare case of temporomandibular joint ankylosis post radiotherapy for management of rhabdomyosarcoma in a 12 years-old boy. A modified gap arthroplasty technique combined simultaneously with pterygo-masseteric muscle flap was applied to lower the risk of osteoradionecrosis due surgical trauma at irradiated area. Computed tomographic scan on the head indicated that the TMJ architecture was completely replaced by bone, with fusion of the condyle, sigmoid notch, and coronoid process to the zygomatic arch and glenoid fossa. The patient's problem was totally solved with no osteoradionecrosis or relapse of ankylosis observed at follow up visits. Herein, the modified gap arthroplasty combined with pterygo-masseteric muscle flap could be recommended to be applied on other cases of ankylosis especially after receiving radiotherapy. [ABSTRACT FROM AUTHOR]

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. 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. 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. 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. [ABSTRACT FROM AUTHOR]

Radiotherapy at the temporomandibular joint (TMJ) area often results in trismus, however, post radiation ankylosis is extremely rare and has not been previously reported in literature. Radiation is known to impact the vasculature of bony structures leading to bone necrosis with certain risk factors including surgical intervention, even teeth extraction, that could lead to osteoradionecrosis. Accordingly, gap arthroplasty for such case seemed rather challenging. In this report, we introduce for the first time, a rare case of temporomandibular joint ankylosis post radiotherapy for management of rhabdomyosarcoma in a 12 years-old boy. A modified gap arthroplasty technique combined simultaneously with pterygo-masseteric muscle flap was applied to lower the risk of osteoradionecrosis due surgical trauma at irradiated area. Computed tomographic scan on the head indicated that the TMJ architecture was completely replaced by bone, with fusion of the condyle, sigmoid notch, and coronoid process to the zygomatic arch and glenoid fossa. The patient’s problem was totally solved with no osteoradionecrosis or relapse of ankylosis observed at follow up visits. Herein, the modified gap arthroplasty combined with pterygo-masseteric muscle flap could be recommended to be applied on other cases of ankylosis especially after receiving radiotherapy.

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. [ABSTRACT FROM AUTHOR]

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.