Shuja Riaz Ansari, Shaheed Iqbal, Saddique Aslam.
Surgical correction of TMJ Ankylosis - A study on the incidence & evaluation of success rates of various surgical procedures.
Pak Oral Dental J Jan ;23(2):105-12.

This study was done to evaluate the incidence of TMJ ankylosis, its etiology, effects of its duration on facial aesthetics, types and stages of ankylosis observed during operation. The success rate of operative procedures was also evaluated by review up to 3 years. The study was carried out on 189 patients with temporomandibularjoint ankylosis during 1996 to 2001, reported at the Maxillo Facial unit of Khyber College of Dentistry, University Campus Peshawar. Aproforma was designed to collect the information about these patients with temporomandibularjoint ankylosis and was filled for each patient with recording of data at, pre, during and post operative stages. All patients were operated under general anaesthesia after excluding any medical problem.4.1 % cases of TMJ ankylosis were treated surgically per year; the main cause was trauma (95.7%), while infection and neoplasm were extremely rare. The other causes as given in the literature could not be related, as no such reports were available. In 3.6% cases etiology was not established. In young and growing children the ankylosis was classified as Type I-IV, whereas, in adult and established cases Topazian`s classification was applied. The effect of duration of ankylosis on facial deformity included facial asymmetry similar to hemi facial microsomia in unilateral cases and retrognathia or microgenia in bilateral cases. The results of surgical relieving of ankylosis proved successfully well in young and growing children, in terms o f mouth opening (30-35mm), facial aesthetics and function. In established cases the results were less promising, the maximum mouth opening achieved was between 20-25mm, had postoperative complications (like posterior gagging or anterior open bite), persisting facial deformity (requiring other surgical corrections) and in few cases re ankylosis required repeated surgical interventions. With in the limitations of this study it is concluded that management of temporomandib ularjoint ankylosis is difficult particularly in long-standing bilateral cases with severe facial deformity. In such cases the success rates were poorer, and there were also relapses mainly due to shortening of ramus length. It is suggested that in all such cases where gap produced after removing of ankylosis, is much larger and ramus length become short, should be corrected by, grafting with costochondral part of rib along with interposition by silastic or temporal muscle flap. In younger age group with early reported cases orpatients with fracture condyles on review, showing progressive reducing mouth opening, early surgical intervention is mandatory and Interpositional arthroplasty with natural disc if found or otherwise temporal muscle must be done.

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