Temporomandibular joint ankylosis: an Indian experience

Area of Science:

• Oral and Maxillofacial Surgery
• Orthopedic Surgery
• Anatomy

Background:

• Temporomandibular joint (TMJ) ankylosis presents significant challenges in treatment and management.
• Understanding the distinct types and characteristics of TMJ ankylosis is crucial for surgical planning.
• Previous studies have highlighted the impact of ankylosis on facial growth and development.

Purpose of the Study:

• To analyze the characteristics of TMJ ankylosis specimens from condylectomy and coronoidectomy procedures.
• To differentiate between intra-articular and juxta-articular TMJ ankylosis.
• To evaluate the outcomes of TMJ arthroplasty, particularly regarding facial growth in pediatric patients.

Main Methods:

• Histopathological and macroscopic examination of 75 TMJ specimens from 61 patients undergoing condylectomy and coronoidectomy.
• Classification of ankylosis into intra-articular and juxta-articular types based on specimen analysis.
• Clinical assessment of facial growth and remodeling in patients who underwent early childhood arthroplasty.

Main Results:

• Two types of TMJ ankylosis were identified: intra-articular (rare, associated with re-ankylosis or infection) and juxta-articular (common, often post-traumatic).
• Juxta-articular ankylosis showed a rudimentary TMJ with an atrophic condylar surface and varying sizes of new bone formation (0.5-3 cm), sometimes fusing with the tympanic plate.
• Temporalis muscle contracture was consistently observed, necessitating coronoid process excision in all arthroplasties. Early arthroplasty did not impede facial growth; it enhanced remodeling.

Conclusions:

• Post-traumatic juxta-articular ankylosis is the predominant form of TMJ ankylosis requiring surgical intervention.
• Mandatory coronoidectomy is essential due to associated temporalis muscle contracture.
• TMJ arthroplasty performed early in childhood positively influences facial growth and remodeling.