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Congenital Temporomandibular Joint Ankylosis: Case Report and Literature Review
Ryan Chin Taw Cheong1, Karim Kassam2, Simon Eccles3
1Colchester Hospital University NHS Foundation Trust, Turner Road, Colchester, Essex CO4 5JL, UK.
Insights
Congenital temporomandibular joint (TMJ) ankylosis, a rare birth condition, presents unique challenges in management. While recurrence is common, surgical intervention can achieve satisfactory maximal incisal opening (MIO).
Area of Science:
- Oral and Maxillofacial Surgery
- Pediatric Dentistry
- Developmental Biology
Background:
- Congenital temporomandibular joint (TMJ) ankylosis is a rare condition presenting at birth, distinct from acquired forms due to infection or trauma.
- It poses unique challenges in pediatric TMJ ankylosis management due to early onset and developmental impacts.
Purpose of the Study:
- To report the management experience of a congenital TMJ ankylosis case.
- To review the literature on congenital TMJ ankylosis management principles and outcomes.
- To highlight the specific challenges associated with the congenital form.
Main Methods:
- Surgical management involving removal of the ankylotic mass.
- Costochondral grafting for reconstruction.
- Postoperative physiotherapy protocols.
- Literature review of congenital TMJ ankylosis cases.
Main Results:
- Recurrence of ankylosis was observed, consistent with literature findings.
- Despite recurrence, satisfactory maximal incisal opening (MIO) was maintained post-operatively.
- Congenital TMJ ankylosis presents greater challenges than acquired forms, including earlier insult, impaired neuromuscular development, and reduced patient compliance.
Conclusions:
- Management of congenital TMJ ankylosis requires aggressive surgical intervention and diligent physiotherapy.
- Relapse is a significant concern, necessitating long-term monitoring.
- Early intervention and tailored physiotherapy are crucial for optimizing outcomes in pediatric patients.
Abstract:
Congenital temporomandibular joint (TMJ) ankylosis is an uncommon condition that presents itself at or soon after birth in the absence of acquired factors that could have contributed to the ankylosis such as infection and trauma. The experience of managing one such case is reported in light of a review of the literature on this condition. Key management principles include adequate removal of the ankylotic mass, costochondral grafting, and post-op physiotherapy. Most patients reported in the literature with the condition experienced relapse. This echoes our own experience where there was recurrence of the ankylosis. However, after removal of the ankylotic mass, the patient maintains a satisfactory maximal incisal opening (MIO) till the present day. The additional challenges faced in the congenital form in addition to the already complex management of acquired paediatric temporomandibular joint ankylosis are (1) much earlier insult to the TMJ, (2) reduced opportunity for neuromuscular development of the muscles of mastication, and (3) reduced compliance with postoperative physiotherapy programmes due to the younger age of these patients.
