Temporomandibular joint ankylosis: the Egyptian experience

This is a review of 204 patients with temporomandibular joint (TMJ) ankylosis treated according to a definitive protocol in the Cranio-Maxillo-Facial Department of the Alexandria University Hospital during the period 1990-1996 with a follow-up varying from 1.5 to 7 years. A history of trauma was confirmed in 98% of cases. Patients were grouped into: (1) Those with ankylosis not associated with facial deformities. The management involves release of the ankylosed joint(s) and reconstruction of the condyle ramus unit(s) (CRUs) using costochondral graft(s) (CCGs). (2) Those with mandibular ankylosis complicated by facial bone deformities, either asymmetric or bird face. The treatment consists of release of the ankylosis, reconstruction of the CRUs, and correction of jaw deformities--all performed simultaneously. Respiratory embarrassment was an important presenting symptom in the second group, all of whom complained of night snoring, eight of whom had obstructive sleep apnoea (OSA). In this latter group, respiratory obstruction improved dramatically after surgical intervention. The degree of mouth opening, monitored as the interincisal distance (IID) improved from a range of 0-12 mm to over 30 mm in 62% of patients and to 20-30 mm in 29% of patients. However, reankylosis was still around 8% and was attributed to lack of patient compliance in 75% and to iatrogenic factors in 25% of patients. CCGs resorption, whether partial or complete, occurred in 27% of patients, resulting in retarded growth, relapse of deformities and night snoring.