ABSTRACT
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.
ABSTRACT
Purpose: The purpose of this clinical study was to evaluate the functional restoration by interpositional arthroplasty with temporalis myofascial flap in temporomandibular joint ankylosis. Methods: After obtaining consent, the procedure were explained to the patient and each of the patients who met the inclusion criteria of the present study were randomly selected. Preoperatively all required investigations were done, fitness opinion for surgery and general anaesthesia was obtained, preoperative mouth opening / interincisal distance was measured with calliper, occlusion recorded, and midline shift was assessed. Surgical procedure (interpositional arthroplasty with temporalis myofascial flap) was carried out under general anaesthesia with endotracheal intubation. And patient was followed for about six months and following parameters were recorded. Mouth opening / interincisal distance, occlusion, Midline shift, Pain and Diet (solid/liquid). Results: In the present study, the temporalis myofascial flap was evaluated to be efficient in preventing the reankylosis. Preoperatively the mean interincisal opening was 6.93mm and post-operatively after a period of 6 months follow-up it remained as 34.93mm. Conclusion: The temporalis myofascial flap is an efficient interpositional material. It is a biologic, autogenous tissue, so there is no question of any rejection. The results of this study indicate that the use of temporalis muscle and fascia flap is effective in treating TMJ ankylosis.
ABSTRACT
BACKGROUND: The purpose of this study was to investigate the functional effects of temporalis myofascial flap after condylectomy, with or without disc removal, in elderly patients with anterior disc displacement (ADD) without reduction and an erosive condylar surface of the temporomandibular joint (TMJ). METHODS: A total of 15 joints from 11 elderly patients (71-78 years old) were included. The patients had pain, mandibular dysfunction symptoms, and unilateral or bilateral ADD as well as an erosive condylar surface of the TMJ. All patients underwent temporalis myofascial flap reconstruction after condylectomy, with or without disc removal. If the maximal mouth opening (MMO) remained <35 mm after condylectomy, coronoidotomy was also performed. Self-assessed pain and mandibular function, including MMO and protrusive and lateral movements, were evaluated. RESULTS: No patient experienced serious complications. Most measurements improved significantly after surgery compared to preoperatively. Most patients achieved nearly-normal mouth opening at 4 weeks after surgery. Although most patients felt discomfort during active postoperative physiotherapy, no patient reported serious pain during the follow-up period. CONCLUSION: Although nonsurgical therapy is often the first treatment choice for ADD without reduction of the TMJ, surgical intervention involving condylectomy and temporalis myofascial flap reconstruction may be a reasonable first option for elderly patients with an erosive condylar surface of the TMJ.
Subject(s)
Aged , Humans , Follow-Up Studies , Joints , Mouth , Temporomandibular JointABSTRACT
Management of temporomandibular joint (TMJ) ankylosis is challenging for the oral and maxillofacial surgeon because it involves the mouth opening, dentofacial deformity, diet problem, and quality of life. Although surgical techniques to treat TMJ ankylosis have improved, reankylosis is a persistent problem. The temporalis myofascial flap provides good material for interpositional arthroplasty, because of its good vascular supply, anatomic proximity, and adequate thickness. This case report examines the efficacy of submandibular anchorage to prevent reankylosis by inhibiting flap dislocation.
Subject(s)
Ankylosis , Arthroplasty , Dentofacial Deformities , Diet , Joint Dislocations , Mouth , Quality of Life , Temporomandibular JointABSTRACT
Subject(s)
Adult , Humans , Ankylosis , Arthroplasty , Follow-Up Studies , Head , Maxillary Artery , Mouth , Spondylitis, Ankylosing , Temporomandibular JointABSTRACT
The treatment of TMJ ankylosis poses a significant challenge because of technical difficulties and high incidence of recurrence. TMJ ankylosis has been treated by excision and total joint reconstruction with alloplastic, allogeneic, autogenous materials as interpositional materials. The temporalis myofascial flap had been considered to be a successful interpositional material, due to its anatomical, topographical, and functional properties. This study evaluated the efficacy of the temporalis myofascial flap for nine TMJs (five patients) through the preauricular approach and coronoidectomy. Radiographic and physiologic long term result was investigated in this study. The result reveals that the temporalis myofascial flap is a good autogenous tissue satisfying the criteria of an ideal interpositional material, which offers a material that fulfills the physiological function of the disc. In spite of favorable functional outcome, mild postoperative openbite tendency remains another challenge.