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A protocol for management of temporomandibular joint ankylosis in children
Leonard B Kaban1, Carl Bouchard, Maria J Troulis
1Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, MA 02114, USA. lkaban@partners.org
Insights
This study outlines a 7-step surgical protocol for treating temporomandibular joint (TMJ) ankylosis in children, emphasizing aggressive resection and early mobilization to reduce recurrence. The protocol aims to improve outcomes for this challenging pediatric condition.
Area of Science:
- Oral and Maxillofacial Surgery
- Pediatric Orthodontics
- Regenerative Medicine
Background:
- Temporomandibular joint (TMJ) ankylosis in children presents significant surgical challenges with high recurrence rates.
- Inadequate ankylotic mass resection and insufficient maximal opening are common causes of treatment failure.
Purpose of the Study:
- To describe a comprehensive 7-step protocol for managing pediatric TMJ ankylosis at Massachusetts General Hospital.
- To detail methods for achieving adequate jaw opening and preventing recurrence.
Main Methods:
- The protocol involves aggressive ankylotic mass excision, bilateral coronoidectomy, TMJ lining with myofascial flaps or native disc, ramus condyle reconstruction (distraction osteogenesis or costochondral graft), and rigid fixation.
- Early jaw mobilization is initiated on the day of surgery for distraction osteogenesis or after 10 days for costochondral grafts.
- Aggressive physiotherapy is a crucial final step for all patients.
Main Results:
- The report presents a case series of pediatric patients treated with this protocol.
- Specific outcomes regarding recurrence rates and maximal incisal opening are detailed within the case series (results not explicitly stated in the abstract).
Conclusions:
- The described 7-step protocol provides a structured approach to surgical correction of pediatric TMJ ankylosis.
- Emphasis on aggressive resection, adequate opening, joint reconstruction, and early mobilization is key to improving treatment success.
Abstract:
Temporomandibular joint (TMJ) ankylosis in children is a challenging problem. Surgical correction is technically difficult and the incidence of recurrence after treatment is high. The purpose of the present report is to describe the protocol currently used at the Massachusetts General Hospital for the management of TMJ ankylosis in children. It has been our observation that the most common cause of treatment failure is inadequate resection of the ankylotic mass and failure to achieve adequate passive maximal opening in the operating room. The 7-step protocol consists of 1) aggressive excision of the fibrous and/or bony ankylotic mass, 2) coronoidectomy on the affected side, 3) coronoidectomy on the contralateral side, if steps 1 and 2 do not result in a maximal incisal opening greater than 35 mm or to the point of dislocation of the unaffected TMJ, 4) lining of the TMJ with a temporalis myofascial flap or the native disc, if it can be salvaged, 5) reconstruction of the ramus condyle unit with either distraction osteogenesis or costochondral graft and rigid fixation, and 6) early mobilization of the jaw. If distraction osteogenesis is used to reconstruct the ramus condyle unit, mobilization begins the day of the operation. In patients who undergo costochondral graft reconstruction, mobilization begins after 10 days of maxillomandibular fixation. Finally (step 7), all patients receive aggressive physiotherapy. A case series of children with ankylosis treated using this protocol is presented.
