Interpositional arthroplasty with temporalis myofascial flap reconstruction in a case of temporomandibular joint bony ankylosis: a case report and review of literature

The report describes the treatment of a 30 year old female patient having unilateral right temporomandibular joint (TMJ) bony ankylosis whose mouth opening was restricted to 5 mm and had additional mandibular retrognathism causing severe mastication problems besides speech difficulties and low morale. The ankylosis had resulted in facial asymmetry due to bony hard swelling in front of right tragus. The patient was taken up for right interpositional arthroplasty with temporalis myofascial flap reconstruction by pre auricular approach and left coronoidectomy by intraoral approach as a preferred technique. A satisfactory mouth opening of 33 mm was achieved in immediate post-operative. Patient was followed up with aggressive mouth opening exercises in postoperative period.

Bony Ankylosis Secondary to Heterotopic Ossification Following Total Knee Arthroplasty: A Case Report

Bony ankylosis secondary to heterotopic ossification following total knee arthroplasty is extremely rare, and to the best of our knowledge, there has been no reported case of this in Korea. We present such a case in a 48 year-old female who underwent primary total knee replacement due to traumatic osteoarthritis.

A Case of Juvenile Ankylosing Spondylitis with Atlantoaxial Bony Ankylosis and Rheumatoid-like Hands / 대한류마티스학회지

Ankylosing spondylitis (AS) is a heterogeneous and systemic rheumatic disorder of unknown cause that is characterized by inflammation of the spine and sacroiliac joints. It is more common in young men. The disease is frequently associated with peripheral arthritis, enthesitis, anterior uveitis and high prevalence of HLA-B27. In some patients with AS, peripheral arthritis can occurs earlier than spinal symptom and more commonly affects the lower extremities than the upper extremities. Unlike men, women appear to have milder or atypical AS, especially at juvenile onset. However, involvement of the hands is extremely rare. Juvenile AS, defined as onset of disease prior to the age of 16 years, is considered a pediatric form of AS. On the other hand, although the atlantoaxial subluxation has been infrequently observed in patients with ankylosing spondylitis, atlantoaxial bony ankylosis has not been described in the literature. We describe a 23-year-old woman with juvenile AS who developed the atlantoaxial bony ankylosis and the hand involvement mimicking rheumatoid arthritis. Besides the rheumatoid-like hands and atlantoaxial bony ankylosis, she has shown the typical features of spondyloarthrpathy such as bilateral sacroiliitis, inflammatory spinal pain, enthesitis, severe arthritis of both hip joints, and positive HLA-B27 test.

Cementless Total Hip Arthroplasty in Bony Ankylosed Hip / 대한정형외과학회잡지

PURPOSE: The purpose of the present retrospective study was to report the clinical and radiological results of 31 total hip arthroplasties of 28 patients with bony ankylosed hip. MATERIALS AND METHODS: Conversions to cementless total hip arthroplasty between August 1983 and May 1999 were reviewed after followups ranging from 3 years 1 month to 18 years. The mean age of the patients at the time of operation was 35.0 years. The mean duration of the ankylosis was 15 years 7 months. RESULTS: At the time of the last follow-up, the mean arc of flexion was 84.6 degrees. The mean Harris hip score improved from 47.7 to 84.9. There were no significant differences in clinical results according to the type and duration of ankylosis. Radiographs showed one acetabular loosening, six acetabular osteolysis and five femoral osteolysis. In cases of osteolysis, the average wear rate was 0.28 mm/year. CONCLUSION: The conversion of bony ankylosed hip to a cementless total hip arthroplasty revealed a favorable outcome, and the risk of failure was found to be unrelated to the type and the duration of ankylosis. However, since some patients show excessive wear with osteolysis, polyethylene liner wear will be of critical importance in terms of long-term results.

Ankylosing Spondylitis Associated With Bilateral TMJ Ankylosis / 대한구강악안면방사선학회지

A 31-year-old male with severe limitation of mouth opening was referred to our department of Chonbuk National University Hospital. The physical status of the patient was hyposthenic. Extraoral examination showed no condylar movement of the both temporomandibular joints, no pain, no faical swelling or paresthesia. Intraoral examination showed several cervical caries on the upper anterior teeth, and gingival swelling on the whole dentition. Transcranial view showed no condylar movement, and narrowing of joint spaces. Chest P-A view showed straightening of thoracic, lumbar spine, and squaring of vertebrae of the same spines. Conventional lateral radiograph of cervical spine showed calcification of the intervertebral ligament. Computed tomograph showed extensive bone formation between temporal bone and the both condylar heads. Labortory findings showed positive reaction on HLA-B27 histocompatibility antigen and increased level of IgA, IgG, ESR. Based on the clinical, radiographic, and the labortary findings, final diagnosis was made as bony ankylosis of the both temporomandibular joints secondary to ankylosing spondylitis.

The surgical correction of the bony ankylosis of the temporomandibular joint.

Bony ankylosis of the temporomandibular joint (TMJ) is an uncommon problem. Since 1997 only seven patients have been treated by the Department of Surgery, three with unilateral involvement and four with bilateral involvement. The associated deformity of the mandible is dependent on the age at the onset of disease or injury. Surgical correction is the only way of treatment, with the main objective being to resume joint movement and jaw function as well as to prevent relapse and, hopefully, restore appearance and occlusion. Surgical procedure included condylectomy with or without coronoidectomy, degloving of the masticator muscles, temporalis muscle flap interposition, costochondral grafting and granioplasty. Postoperative wound infection was found in three patients, one died of gentamicin-induced renal failure six weeks postoperatively. In the long-term follow-up, one patient developed recurrence that was successfully treated repeated surgery.