Temporomendibular Joint (TMJ) Ankylosis - 謝明吉、姜厚任 顎顏面 美學 重建 專科診所-風華整形聯合診所
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Physiology and pathology of the TMJ
Temporomendibular Joint (TMJ) Ankylosis
簡介


 

Temporomendibular Joint (TMJ) Ankylosis

TMJ ankylosis refers to intra-articular fibrous or bony adhesions leading to functional loss (e.g. inability to open mouth or chew) (Gundlach KK, 2010). Many factors may cause TMJ ankylosis, including trauma, infection, arthritis, underwent several times of joint surgery, congenial abnormalities. Trauma, in particular condylar fracture, is the major cause of TMJ ankylosis (Kaban LB, 1990; Chidzonga MM, 1999).
 

Etiology of TMJ Ankylosis

After TMJ trauma, it takes a long time to form TMJ ankylosis, can be several months or even decades after trauma.
 

TMJ ankylosis forms after condyle fracture which leads to the damage of capsular ligamenta and surrounding periosteum and the formation of heamarthrosis, resulting in osteoproliferation (simply speaking the blood clot gradually turns into bone) and eventually bony ankylosis (Sawhney CP, 1986;Oe K, 2007).
 

Clinical diagnosis of TMJ ankylosis depends on physical examination and imaging examinations including CT scan, MRI and 3D digital reconstruction. The imaging examinations allow identification of the position and range of the fibrous and bony adhesions in clear vision.
 



 

TMJ ankylosis and dentofacial deformity
If TMJ ankylosis happens during the bone growth stage, mandibular development will be affected, which leads to dentofacial deformity and even worse may affect chewing function, pronunciation, oral hygiene and cause mental disorders. Facial asymmetry and micrognathia are the most common development abnormalities coupled with TMJ ankylosis.
 

Condylar fracture in adults not treated in a timely and appropriate manner will result in TMJ ankylosis that may cause malocclusion (e.g. open bite), facial asymmetry, retrognathia, pain while opening mouth and difficulty chewing.
 

Young or adult patients with TMJ ankylosis combined with severe retrognathia may develop obstructive sleep apnea (OSA) due to compressed upper respiratory tracts (mouth and larynx).


 

Treament of TMJ Ankylosis

Treatment goals for TMJ ankylosis include 1) restoration of TMJ functions, 2) correction of facial asymmetry, 3) correction of dental malocclusion, and 4) prevention of ankylosis recurrence.
 

First step to restore the motion range of TMJ is removing the ankylotic bony mass. This procedure is called gap anthroplasty.

 

Then orthognathic surgery is applied to correct facial asymmetry and malocclusion. Key of a successful orthognathic surgery is a well-functioned TMJ. In order to restore the motion range of TMJ, the ankylotic mass has to be removed, also the deformed condylar head. Therefore TMJ reconstruction is one of the main focuses in the surgical treatment of TMJ Ankylosis.
 

Different methods can be applied for TMJ reconstruction with varied success rates. In our clinic, we recommends the surgical option reaching high success rate of 85-90% for 10 years, and the only method that fulfills this criterion is total joint reconstruction (TJR). Latest study investigating 56 patients underwent TJR for more than 20 years showed that the patient satisfaction rate was higher than 85% and none of the patient received a secondary surgery (Wolford LM,2015).
 

In addition, as most patients with TMJ ankylosis also exhibit facial deformities, TJR is the only surgical approach that can combine with orthognathic surgery and treat MTJ ankylosis, facial deformities and mal occlusion simultaneously (Wolford LM,1994,2015; Granquist EJ,2011; Mercuri LG, 1995)
 


Almost all cases of TMJ ankylosis occurring during bone growth stage will affect oral-maxillofacial development and may cause persistent pain, malocclusion and retrognathia or mandibular deviation in adulthood.
 

Such disease was a very difficult and problematic issue for oral maxillofacial surgeons during the time when computer technology was not mature and widely available, as the surgeon had to restore TMJ functions, stabilize occlusion and achieve symmetric and proportional appearance at once while performing the surgery. Nowadays with the assistance of advanced medical technologies, biomaterials, 3d remodeling and 3D printing technologies, the surgeons can perform digital navigation guided surgery to reconstruct the joint and relocate the jaw bones accurately while minimizing surgical wound, improving joint stability and reestablishing symmetrical appearance and occlusion.

 

 

Results of surgery vary among patients. Please consult your doctor.
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Copyright © 2007-2017 

All Written Contents and Pictures Created by Dr. Adrian M. Hsieh and Dr. Scott H. Jiang

 

 

 

 

Results of surgery vary among patients. Please consult your doctor.