Management of Temporomandibular Joint Ankylosis With TMJ Concepts Prosthesis: Retrospective Review of 31 Cases and Outcome Assessment
Background: The TMJ ankylosis is a debilitating condition which interferes with patients ability to masticate, speak, maintain good oral hygiene, and carry on normal life.
Objective: To report the outcome assessment of 28 patients with temporomandibular joint ankylosis treated with patient fitted total joint prosthesis.
Methods and Material: The records of patients with TMJ ankylosis from a single private practice from 1992 to 2011 were retrospectively analyzed. A total of 28 patients (7 male, 22 female) were diagnosed with bony ankylosis, which matched the following criteria: 1) Radiographic evidence of bony ankylosis, 2) limited maximal incisal opening and restricted range of motion, 3) Minimum of 12-months follow-up (range 12-192 months), and 4) All patients were treated using TMJ concepts patient fitted prosthesis and fat graft. The subjective (TMJ pain, headaches, jaw function, diet, disability) and objective (maximal incisal opening, excursive movements) evaluation of all subjects were performed and the data analyzed. The data was also subcategorized based on the following: 1) Number of previous TMJ surgeries (0-1 surgeries, 2-3 surgeries, >4 surgeries), 2) Adult vs. Pediatric group, and 3) Use of Proplast Teflon as one of the previous surgeries. Subjective and objective evaluation were compared using paired T-test analysis.
Results: The subjective values improved by an average of 4.2 points. The maximum incisal opening improved from 14mm to 32.5mm. Excursive movements improved by an average of 1.2mm. No complications were encountered in the follow up period.
Conclusion: Number of previous surgeries significantly effected the outcome. History of Proplast Teflon had no significant influence on the results. Patient fitted TJP with fat grafts is a successful method to treat TMJ ankylosis.
References:
1. Topazian RG: Etiology of ankylosis of temporomandibular joint: Analysis of 44 cases. J Oral Surg Anesth Hosp Dent Serv 22:227,1964
2. Wolford et al. Custom-made total joint prostheses for temporomandibular joint reconstruction. Proc (Bayl Univ Med Cent). 2000 April; 13(2): 135–138.