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Ankylosis of the Temporomandibular Joint in Pediatric Patients
Collin Rozanski1, Kasey Wood1, Paymon Sanati-Mehrizy2
1Icahn School of Medicine at Mount Sinai.
Insights
Gap arthroplasty is recommended for pediatric temporomandibular joint (TMJ) ankylosis repair due to its technical ease and comparable outcomes to other methods. Postoperative physiotherapy is crucial to prevent re-ankylosis.
Area of Science:
- Orthopedic Surgery
- Pediatric Surgery
- Maxillofacial Surgery
Background:
- Temporomandibular joint (TMJ) ankylosis presents challenges in pediatric patients, with varied surgical approaches lacking a clear consensus.
- Surgical options include gap arthroplasty, interpositional arthroplasty, and total joint reconstruction.
Purpose of the Study:
- To systematically review and compare the efficacy of different surgical modalities for treating TMJ ankylosis in pediatric patients.
- To evaluate outcomes such as maximum interincisal opening (MIO) and complication rates, including re-ankylosis.
Main Methods:
- A systematic review of PubMed and Scopus databases (1990-2017) was conducted.
- Studies included pediatric patients (<18 years) with TMJ ankylosis undergoing surgical correction.
- Primary outcomes analyzed were MIOpreop, MIOpostop, ΔMIO, and complications.
Main Results:
- Twenty-four studies involving 176 patients and 227 joints were analyzed.
- Gap arthroplasty and interpositional arthroplasty showed significantly greater MIOpostop and ΔMIO compared to reconstruction.
- No significant difference in re-ankylosis rates (2.27%) was observed between the surgical interventions.
Conclusions:
- Gap arthroplasty is a technically straightforward option for primary TMJ ankylosis repair in pediatric patients.
- Outcomes regarding MIO and re-ankylosis rates are comparable between gap arthroplasty and interpositional arthroplasty.
- Emphasis on postoperative physiotherapy is vital to minimize the risk of recurrent ankylosis.
Introduction:
While surgical interventions for temporomandibular joint (TMJ) ankylosis are well-documented, there is lack of consensus regarding the ideal approach in pediatric patients. Surgical interventions include gap arthroplasty, interpositional arthroplasty, or total joint reconstruction.
Methods:
A systematic review of PubMed (Jan 1, 1990-Jan 1, 2017) and Scopus (Jan 1, 1990-Jan 1, 2017) was performed and included studies in English with at least one patient under the age of 18 diagnosed with TMJ ankylosis who underwent surgical correction. Primary outcomes of interest included surgical modality, preoperative maximum interincisal opening (MIO) (MIOpreop), postoperative MIO (MIOpostop), ΔMIO (ΔMIO = MIOpostop - MIOpreop), and complications.
Results:
Twenty-four case series/reports with 176 patients and 227 joints were included. By independent sample t tests MIOpostop (mm) was greater for gap arthroplasty (30.18) compared to reconstruction (27.47) (t = 4.9, P = 0.043), interpositional arthroplasty (32.87) compared to reconstruction (t = 3.25, P = 0.002), but not for gap compared to interpositional (t = -1.9, P = 0.054). ΔMIO (mm) was greater for gap arthroplasty (28.67) compared to reconstruction (22.24) (t = 4.2, P = 0.001), interpositional arthroplasty (28.33) compared to reconstruction (t = 3.27, P = 0.002), but not for interpositional compared to gap (t = 0.29, P = 0.33). Weighted-average follow-up time was 28.37 months (N = 164). 4 of 176 (2.27%) patients reported development of re-ankylosis. There was no significant difference in occurrence of re-ankylosis between interventions.
Conclusions:
Given the technical ease of gap arthroplasty and nonsignificant differences in ΔMIO, MIOpostop, or occurrence of re-ankylosis between gap and interpositional arthroplasty, gap arthroplasty should be considered for primary ankylosis repair in pediatric patients, with emphasis on postoperative physiotherapy to prevent recurrent-ankylosis.
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