Is Entire Removal of a Post-Traumatic Temporomandibular Joint Ankylotic Site Necessary for an Optimal Outcome?

The role of physiotherapy interventions in the management of temporomandibular joint ankylosis: a systematic review and meta-analysis : Running title: Physiotherapy in TMJ ankylosis

BACKGROUND

The main aim of this systematic review and meta-analysis was to identify peer-reviewed scholarly journal articles reporting the significance of physiotherapy interventions in managing TMJ ankylosis. In addition, this study aimed to critically appraise the existing evidence on the prevalence and clinical presentation, physiotherapy intervention approaches, efficacy of physiotherapy interventions, adverse effects, and safety of physiotherapy interventions in TMJ ankylosis management.

METHODS

An all-inclusive literature search was conducted using the PubMed, Google Scholar, and Scopus electronic databases. The researchers screened the potential articles and assessed for eligibility based on the reported inclusion and exclusion criteria. The quality evaluation tool for observational cohort and cross-sectional studies developed by the National Institutes of Health (NIH) and the Cochrane Collaboration's Risk of Bias Tool were used to assess the quality of the included studies. Researchers also comprehensively analyzed the data, reported the results, and discussed them according to the predominant themes.

RESULTS

The primary electronic database search yielded 409 articles, of which 25 were included in this review. A secondary search was conducted from citations of the included studies, yielding 74 articles, of which six were included in the study. A significantly higher prevalence of bony ankylosis than fibrous ankylosis, with an overall effect size of p < 0.00001. In addition, there were significantly more unilateral than bilateral presentations with an overall effect size of p < 0.00001. Moreover, there were 78 reported complications out of 245 subjects according to five included studies demonstrating a significant effect size with p = 0.001 following the treatment protocols.

CONCLUSION

This study highlighted the prevalence of bony ankylosis in temporomandibular joint ankylosis, emphasizing its impact on patients' well-being. On the other hand, the results show that physiotherapy is essential to optimize postoperative outcomes and minimize adverse events such as re-ankylosis. Practitioners and healthcare professionals must monitor postoperative recovery and ensure strict adherence to physiotherapy protocols for optimal outcomes.

Management of paediatric ankylosis

Temporomandibular joint ankylosis (TMJa) is one of the most crippling craniomaxillofacial pathological conditions characterized by replacement of normal architecture of temporomandibular joint (TMJ) with fibrous or bony tissue. The incidence of TMJa is most common in the paediatric population [first and second decades of life] and is commonly associated with maxillofacial trauma. Comprehensive management entails a thorough evaluation of the associated anatomy of the ankylotic mass and other pertinent details like the presence or absence of obstructive sleep apnoea. Categorizing patients based on these variables helps in selecting an appropriate surgical intervention. Various resective and reconstructive surgical techniques are discussed; along with their merits and demerits. Long-term physiotherapy, long-term clinical follow-up and appropriate family counselling are the essential pillars for success. In this review, the authors present an algorithmic approach to evaluation and management of paediatric TMJa. Appropriate recommendations are made based on evidence to select optimum surgical intervention.

Temporomandibular Joint Ankylosis Surgery in Children

PURPOSE

A variety of techniques have been described in the literature for the treatment of temporomandibular joint ankylosis. However, 1 of the factors most commonly related to the failure of maintenance mouth opening in the postoperative period is the inadequate excision of the ankylotic mass. Furthermore, the surrounding noble structures, such as the base of the skull, internal maxillary artery, and dental germs, are at risk of being affected during the procedure.

MATERIALS AND METHODS

For this reason, prototyped guides have been proposed to steer osteotomies and resections of the ankylotic block in the temporomandibular joint.

RESULTS

Nevertheless, access to this technology, especially in developing countries, can represent a financial barrier.

CONCLUSION

Therefore, our proposal is to manufacture low-cost surgical cutting guides to increase their applicability.

Evaluation of the condyle remodeling after lateral arthroplasty in growing children with temporomandibular joint ankylosis

Temporomandibular joint (TMJ) ankylosis in growing patients can cause both mouth opening limitation and jaw bone deformity. Lateral arthroplasty (LAP) can restore the medially displaced condyle and thus keep its growth potential. But can the condyle grow as normal is unknown. This study was to evaluate the long-term result after LAP in growing children. Patients from 2010 to 2014 were evaluated. Their CT data within 1 week after operation and during at least 1-year follow-ups were measured by ProPlan CMF 1.4 software. The condyle-ramus length of both sides and angles and the chin deviation before and after operation were compared. SPSS 17.0 software was used for statistical analysis. A total of 9 patients with a mean age of 10.2 years were included in the study. The mean follow-up period was 1.94 years. The mean condyle-ramus growth was 2.90 mm in the affected side and 2.50 mm in the unaffected side (P = 0.31). All of the affected side exhibited growth and remodeling of the condyle and ramus. All 9 cases had a mean chin deviation of 3.69 mm before operation and 2.92 mm during follow-ups (P = 0.16). The residual condyle grows after LAP, which can reduce the gravity of jawbone deformity.

Simultaneous treatment of temporomandibular joint ankylosis with severe mandibular deficiency by standard TMJ prosthesis

Temporomandibular joint (TMJ) ankylosis is a refractory disease that is difficult to predictably treat. This study evaluated the prognosis of using standard alloplastic TMJ prostheses for the treatment of TMJ ankylosis in Chinese patients with severe mandibular deficiency. Patients treated from 2013 to 2015 were reviewed. The computer-aided design and manufacture (CAD/CAM) technique was used to guide bony mass removal and locate the TMJ prosthesis (Biomet, USA). Eleven patients were included in this study. All prostheses were successfully installed and stabilized intraoperatively. In 4 patients with severe mandibular deficiency, their mandibular ramus was elongated by the TMJ prosthesis and 2 patients were combined with Le Fort I osteotomy guided by digital templates. Their mean chin advancement was 10.19 mm. Their SNB and ramus heights were also significantly improved after operation (P < 0.05). There was no prosthesis loosening, breakage, or infection leading to removal after a mean follow-up period of 22 months (range, 12-31mos.). Mouth opening was significantly improved from 5.5 mm preoperatively to 31.5 mm postoperatively. TMJ reconstruction with standard alloplastic prosthesis is a reliable treatment for ankylosis, especially in recurrent cases. By CAD/CAM technique, it can correct jaw deformities simultaneously and produce stable results.

Post-Ankylotic Temporomandibular Joint Reconstruction Using Autogenous/Alloplastic Materials: Our Protocol and Treatment Outcomes in 22 Patients

The purpose of this study was to evaluate the various options of autogenous and alloplastic reconstruction modalities available for posttraumatic temporomandibular joint (TMJ) ankylosis. In a retrospective study of 22 patients, various autogenous/alloplastic materials were used based on type and severity of ankylosis and age of patient. Final outcome of reconstruction was critically evaluated in terms of maximal mouth opening, occlusion, and facial symmetry. Fourteen patients (63.63%) developed TMJ ankylosis due to road traffic accidents and eight patients (36.36%) had a history of fall. The mean age was 15.61 years. The mean preoperative maximum interincisal mouth opening (MIMO) for the entire series was 3.39 mm ± 2.16 and postoperative MIMO was 43.69 mm ± 2.63. Costochondral grafts were used in seven children, whereas titanium reconstruction plate with condylar head was used in five adults and interpositional arthroplasties using temporalis muscle, temporalis fascia, and relocation of the articular disc were used in the rest of the ten patients. We conclude that all these age-specific treatment modalities yield clinically comparable results in terms of postoperative mouth opening and facial symmetry with no evidence of reankylosis in a follow-up ranging from 24 to 96 months.

Late reconstruction of condylar neck and head fractures

Condyle fractures are a common injury, but only a few of these injuries require immediate or late reconstruction. The complications that most frequently necessitate condylar reconstruction include proximal segment degeneration, malunion, and ankylosis. Costochondral grafts and total joint prostheses, both stock and custom, remain the most common methods of reconstruction. Reconstruction plates with condylar extensions should only be used temporarily as an unacceptable number cause serious complications. Distraction osteogenesis may have an occasional role in reconstructing the posttraumatic condyle.