Modified temporalis anchorage in craniomandibular reankylosis

This study evaluates the long-term outcomes and clinical results of costochondral graft and temporalis muscle flap interpositioning with submandibular anchorage in the management of TMJ re-ankylosis. Thirty-one patients, 9 children and 22 adults, with recurrence of ankylosis after gap arthroplasty, with a mouth opening less than 5 mm were evaluated. The management protocol consisted of resection of the ankylotic mass through an Al-Kayat and Bramley incision; contralateral coronoidectomy in unilateral cases; replacement of the condyle in children by means of a costochondral graft through Risdon's approach and interpositional temporalis muscle flap and submandibular anchorage of the temporalis flap in children and adults. Regular clinical and radiological follow up was done for 6 years during which the average mouth opening of 38 mm was maintained, with good occlusion and proper function. The temporalis muscle flap was seen to be an ideal interpositional material due to its close proximity to the site, good vascular supply, ease of access to the condyle area and minimal risk of nerve damage. Submandibular anchorage of the broad temporalis muscle flap prevents reankylosis by inhibiting flap contraction, and decreases need for rigorous physiotherapy.