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Significance of medio-lateral depth (MLD) in TMJ ankylosis surgery-A newer severity index (VSI) based surgical
Venkatesh Anehosur1, Saurav Bhaduri2, Akshay A Byadgi2
1Department of Oral & Maxillofacial Surgery, SDM Craniofacial Research Centre, SDM College of Dental Sciences & Hospital, A Constituent Unit of Shri Dharmasthala Manjunatheshwara University, Hubli, Karnataka, 580009, India. venkyrao12@yahoo.co.in.
Introduction:
Temporomandibular joint (TMJ) ankylosis is a debilitating disorder caused by fibrous or osseous fusion of the joint components, significantly restricting mandibular mobility. As TMJ ankylosis disrupts normal facial growth, resulting in persistent functional and aesthetic challenges. The Medio-Lateral Depth (MLD) of the bony ankylotic mass is a vital yet underexplored factor influencing the complexity of surgery. Increased MLD and density of the ankylotic mass significantly elevate surgical complexity and the risk of postoperative complications. This study aims to assess the role of the Medio-Lateral Depth (MLD) of the bony ankylotic mass in influencing surgical outcomes (operative time, intraoperative blood loss, complication rates, hospital stay, etc.) and specific indicators of morbidity.
Materials:
and Methodology. This study was designed as a prospective single centre, cohort study. The medio-lateral depth (MLD) was measured pre-operatively by CT scan and intra operatively by depth gauge scale.Other post operative surgical outcomes were correlated to the MLD.
Results:
34 patients were included in the study. In the Outcomes-based severity index fit assessment the predictors especially CT Depth and Intra-op Depth explain the intercept severity classification perfectly and Chi-square = 51.66, p < 0.001 → chi square value shows very significant outcomes variable. Significant correlations were also found between MLD intra-op and drain collection on POD-1 (R = 0.5793, p = 0.0003). The cases in this series were classified into mild, moderate and severe cases depending on the variability of MLD measured preoperatively by CT scan and Intra operative MLD therefore nomenclated as Venkatesh MLD severity index (VSI) for ankylotic mass. Mild < 2.5 cm, Moderate 2.5 cm to 4.0 cm and Severe > 4.0 cm.
Conclusion:
Increasing MLD in ankylotic masses is strongly associated with surgical complexity, intraoperative challenges, and postoperative recovery. MLD remains a pivotal prognostic anatomical parameter, influencing operative time, blood loss, and recovery trajectories. To optimize surgical outcomes, the protocol must integrate advanced preoperative imaging and meticulous planning, with a specific focus on MLD-informed surgical training.
