The korean journal of orthodontics (대한치과교정학회지)

The Korean Association Of Orthodontists (대한치과교정학회)
권호 표지
DOI QR코드

DOI QR Code

Longitudinal management of recurrent temporomandibular joint ankylosis from infancy to adulthood in perspective of surgical and orthodontic treatment

  • Lim, Seung-Weon (Department of Orthodontics, Seoul National University Dental Hospital) ;
  • Choi, Jin-Young (Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University) ;
  • Baek, Seung-Hak (Department of Orthodontics, School of Dentistry, Seoul National University)
  • Received : 2018.10.11
  • Accepted : 2018.11.20
  • Published : 2019.11.25
Download PDF
⟨ Previous Next ⟩

Abstract

This study was performed to describe the longitudinal management of recurrent temporomandibular joint (TMJ) ankylosis from infancy to adulthood in perspective of surgical and orthodontic treatment. A 2-year-old girl was referred with chief complaints of restricted mouth opening and micrognathia due to bilateral TMJ ankylosis. For stage I treatment during early childhood (6 years old), high condylectomy and interpositional arthroplasty were performed. However, TMJ ankylosis recurred and symptoms of obstructive sleep apnea (OSA) developed. For stage II treatment during early adolescence (12 years old), gap arthroplasty, coronoidectomy, bilateral mandibular distraction osteogenesis, and orthodontic treatment with extraction of the four first premolars were performed. However, TMJ ankylosis recurred. Because the OSA symptoms reappeared, she began to use a continuous positive airway pressure device. For stage III treatment after completion of growth (20 years old), low condylectomy, coronoidectomy, reconstruction of the bilateral TMJs with artificial prostheses along with counterclockwise rotational advancement of the mandible, genioglossus advancement, and orthodontic treatment were performed. After stage III treatment, the amount of mouth opening exhibited a significant increase. Mandibular advancement and ramus lengthening resulted in significant improvement in the facial profile, Class I relationships, and normal overbite/overjet. The OSA symptoms were also relieved. These outcomes were stable at the one-year follow-up visit. Since the treatment modalities for TMJ ankylosis differ according to the duration of ankylosis, patient age, and degree of deformity, the treatment flowchart suggested in this report could be used as an effective guideline for determining the appropriate timing and methods for the treatment of TMJ ankylosis.

Keywords

References

  1. Kazanjian VH. Temporomandibular joint ankylosis with mandibular retrusion. Am J Surg 1955;90:905-10. https://doi.org/10.1016/0002-9610(55)90721-2
  2. Kaban LB, Perrott DH, Fisher K. A protocol for management of temporomandibular joint ankylosis. J Oral Maxillofac Surg 1990;48:1145-51; discussion 1152. https://doi.org/10.1016/0278-2391(90)90529-B
  3. Ko EW, Huang CS, Chen YR. Temporomandibular joint reconstruction in children using costochondral grafts. J Oral Maxillofac Surg 1999;57:789-98; discussion 799-800. https://doi.org/10.1016/S0278-2391(99)90816-9
  4. Kaban LB, Bouchard C, Troulis MJ. A protocol for management of temporomandibular joint ankylosis in children. J Oral Maxillofac Surg 2009;67:1966-78. https://doi.org/10.1016/j.joms.2009.03.071
  5. Vasconcelos BC, Bessa-Nogueira RV, Cypriano RV. Treatment of temporomandibular joint ankylosis by gap arthroplasty. Med Oral Patol Oral Cir Bucal 2006;1:E66-9.
  6. Topazian RG. Comparison of gap and interposition arthroplasty in the treatment of temporomandibular joint ankylosis. J Oral Surg 1966;24:405-9.
  7. Cheung LK, Lo J. The long-term effect of transport distraction in the management of temporomandibular joint ankylosis. Plast Reconstr Surg 2007;119:1003-9. https://doi.org/10.1097/01.prs.0000252499.90628.1d
  8. Stucki-McCormick SU. Reconstruction of the mandibular condyle using transport distraction osteogenesis. J Craniofac Surg 1997;8:48-52; discussion 53. https://doi.org/10.1097/00001665-199701000-00016
  9. Lopez EN, Dogliotti PL. Treatment of temporomandibular joint ankylosis in children: is it necessary to perform mandibular distraction simultaneously? J Craniofac Surg 2004;15:879-84; discussion 884-5. https://doi.org/10.1097/00001665-200409000-00037
  10. Peltomaki T. Growth of a costochondral graft in the rat temporomandibular joint. J Oral Maxillofac Surg 1992;50:851-7; discussion 857-8. https://doi.org/10.1016/0278-2391(92)90278-8
  11. Henry CH, Wolford LM. Reconstruction of the tem-poromandibular joint using a temporalis graft with or without simultaneous orthognathic surgery. J Oral Maxillofac Surg 1995;53:1250-6; discussion 1256-7. https://doi.org/10.1016/0278-2391(95)90579-0
  12. van Loon JP, de Bont GM, Boering G. Evaluation of temporomandibular joint prostheses: review of the literature from 1946 to 1994 and implications for future prosthesis designs. J Oral Maxillofac Surg 1995;53:984-96; discussion 996-7. https://doi.org/10.1016/0278-2391(95)90110-8
  13. Wolford LM, Karras S, Mehra P. Concomitant temporomandibular joint and orthognathic surgery: a preliminary report. J Oral Maxillofac Surg 2002;60:356-62; discussion 362-3. https://doi.org/10.1053/joms.2002.31220
  14. Coleta KE, Wolford LM, Goncalves JR, Pinto Ados S, Cassano DS, Goncalves DA. Maxillo-mandibular counter-clockwise rotation and mandibular advancement with TMJ Concepts total joint prostheses: part II--airway changes and stability. Int J Oral Maxillofac Surg 2009;38:228-35. https://doi.org/10.1016/j.ijom.2008.11.021
  15. Yadav R, Bhutia O, Shukla G, Roychoudhury A. Distraction osteogenesis for management of obstructive sleep apnoea in temporomandibular joint ankylosis patients before the release of joint. J Craniomaxillofac Surg 2014;42:588-94. https://doi.org/10.1016/j.jcms.2013.07.031
  16. Hagg U, Taranger J. Maturation indicators and the pubertal growth spurt. Am J Orthod 1982;82:299-309. https://doi.org/10.1016/0002-9416(82)90464-X
  17. Dela Coleta KE, Wolford LM, Goncalves JR, Pinto Ados S, Pinto LP, Cassano DS. Maxillo-mandibular counter-clockwise rotation and mandibular advancement with TMJ Concepts total joint prostheses: part I--skeletal and dental stability. Int J Oral Maxillofac Surg 2009;38:126-38. https://doi.org/10.1016/j.ijom.2008.11.024
  18. Wolford LM, Cottrell DA, Henry CH. Temporomandibular joint reconstruction of the complex patient with the Techmedica custom-made total joint prosthesis. J Oral Maxillofac Surg 1994;52:2-10; discussion 11. https://doi.org/10.1016/0278-2391(94)90003-5
  19. Wojczynska A, Leiggener CS, Bredell M, Ettlin DA, Erni S, Gallo LM, et al. Alloplastic total temporomandibular joint replacements: do they perform like natural joints? Prospective cohort study with a historical control. Int J Oral Maxillofac Surg 2016;45:1213-21. https://doi.org/10.1016/j.ijom.2016.04.022
  20. Wolford LM, Mercuri LG, Schneiderman ED, Movahed R, Allen W. Twenty-year follow-up study on a patient-fitted temporomandibular joint prosthesis: the Techmedica/TMJ Concepts device. J Oral Maxillofac Surg 2015;73:952-60. https://doi.org/10.1016/j.joms.2014.10.032
  21. Mercuri LG, Giobbie-Hurder A. Long-term outcomes after total alloplastic temporomandibular joint reconstruction following exposure to failed materials. J Oral Maxillofac Surg 2004;62:1088-96. https://doi.org/10.1016/j.joms.2003.10.012