Challenges in Managing Post-Radiation TMJ Pseudoankylosis.

Area of Science:

• Oncology
• Oral and Maxillofacial Surgery
• Reconstructive Surgery

Background:

• Maxillary squamous cell carcinoma treatment can lead to complications.
• Radiation therapy and surgical reconstruction can cause temporomandibular joint (TMJ) pseudoankylosis.
• Severe jaw hypomobility (maximal mouth opening < 5 mm) significantly impacts patient quality of life.

Purpose of the Study:

• To evaluate the management outcomes of post-radiation TMJ pseudoankylosis.
• To identify challenges in restoring jaw function after cancer treatment.
• To assess the effectiveness of surgical intervention and rehabilitation.

Main Methods:

• Subtotal maxillary resection for squamous cell carcinoma.
• Bilateral coronoidectomy concurrent with maxillary reconstruction.
• Buccal fibrosis release and intensive jaw exercises.
• Follow-up assessment of maximal mouth opening (MMO).

Main Results:

• Maximal mouth opening (MMO) improved from < 5 mm to 20 mm at 16 months post-surgery.
• Bilateral coronoidectomy addressed temporalis muscle attachments but not all trismus causes.
• Progressive fibrosis and soft tissue abnormalities remained significant challenges.

Conclusions:

• Surgical management combined with rehabilitation can improve MMO in TMJ pseudoankylosis.
• Radiotherapy-induced trismus may require multimodal approaches beyond surgery and exercise.
• Further interventions may be necessary for refractory cases to achieve optimal jaw mobility.