Title: Temporalis Myofascial Flap Interpositional Arthroplasty with Bilateral Coronoidectomy for Management of Unilateral TMJ Ankylosis: A Retrospective Study
Author: Pramod Sharma
DOI: https://dx.doi.org/10.18535/jmscr/v6i8.75
Abstract
Introduction: Temporomandibular joint (TMJ) ankylosis is an extremely disabling condition seen commonly. Surgical management of TMJ ankylosis needs careful planning and thorough evaluation to achieve good results.
Aims & Objectives: This study was conducted with the aim to evaluate the role of interpositional arthroplasty using temporalis myofascial flap with bilateral coronoidectomy in achieving maximum interincisal mouth opening (MIO) in unilateral TMJ ankylosis.
Materials and Methods: A total of 16 patients with unilateral TMJ ankylosis were included in the study. The patients underwent interpositional arthroplasty using temporalis myofscial flap along with bilateral coronoidectomy under general anaesthesia. Pre and post operative MIO’s were measured.
Results: The mean MIO after osteoarthrectomy and ipsilateral coronoidectomy was 33.5mm. The mean MIO after bilateral coronoidectomy was 42.1mm. The mean increase in MIO after bilateral coronoidectomy was 8.75mm. There were no recurrences in any patient in this study.
Conclusion: The present study shows that temporalis myofascial flap is a good choice for interpositional arthroplasty for management of TMJ ankylosis. Bilateral coronoidectomy in unilateral TMJ ankylosis gives better intraoperative mouth opening which was maintained in the long term.
Keywords: TMJ Ankylosis, Temporalis, Myofascial, Arthroplasty, Interpositional arthroplasty, TMJ Surgery.
References
- Sugar AW, Pradhan R. Temporomandibular joint ankylosis in the growing child: costochondral grafting as an approach to management. Ind J Surg.1984;252-362
- Chidzonga MM. Temporomandibular joint ankylosis: review of thirty-twocases. Br J Oral Maxillofac Surg.1999 Apr;37(2):123-6.
- Roychoudhury A, Parkash H, Trikha A. Functional restoration by gap arthroplasty in temporomandibular joint ankylosis: a report of 50 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999 Feb;87(2):166-9.
- Güven O. Treatment of temporomandibular joint ankylosis by a modified fossa prosthesis. J Craniomaxillofac Surg. 2004 Aug;32(4):236-42.
- Su-Gwan K. Treatment of temporomandibular joint ankylosis with temporalis muscle and fascia flap. Int J Oral Maxillofac Surg. 2001 Jun;30(3):189-93.
- Kazanjian VH: Temporo-mandibular ankylosis with mandibular retrusion. American Journal of Surgery, 1955;90: 905-910.
- Al kayat A, Bramley P: A modified pre-auricular approach to the Temporo-mandibular joint and molar arch. British Journal of Oral Surgery, 1979; 17:91-103.
- Rowe NL. Ankylosis of the temporomandibular joint. J Royal College of Surgeons of Edinburgh.1982:27(2);67-79
- Laskin DM: Role of the meniscus in the etiology of post traumatic temporoman-dibular joint ankylosis. International Journal of Oral Surgery, 978;7(4):340-345.
- Kaban LB, Perrott DH, Fisher K. A protocol for management of temporomandibular joint ankylosis. J Oral Maxillofac Surg, 1990;48(11):1145-1151.
- Chossegros C, Guyot L, Cheynet F, Blanc JL, Gola R, Bourezak Z, et al. Comparison of different materials for interposition arthroplasty in treatment of temporomandibular joint ankylosis surgery: Long‑term follow‑up in 25 cases. Br J Oral Maxillofac Surg 1997;35:157‑60
- Pogrel MA, Kaban LB: The role of a temporalis fascia and muscle flap in temporomandibular joint surgery.Journal of Oral and Maxillofacial Surgery, 1990; 48(1):14-19.
- Khadka A, Hu J. Autogenous grafts for condylar reconstruction in treatment of TMJ ankylosis: current concepts and considerations for the future. J. Oral Maxillofac. Surg. 2012; 41: 94-102.
- Umeda H, Kaban LB, Pogrel MA,Stren M, Rotskoff KS:Long-term viability of temporalis muscle/fascia flap usedfor temporomandibular reconstruction. Journal of Oral and Maxillofacial Surgery, 1993;51(5): 530-534.
- Feinberg SE, Larsen PE: The use of a pedicled temporalis muscle-pericranial flap for replacement of the TMJ disc: preliminary report. Journal of Oral and Maxillofacial Surgery, 1989; 47: 142-146.
- Smith JA, Sandler NA, Ozaki WH, Braun TW: Subjective and objective assessment of the temporal myofascial flap in previously operated temporomandibular joints.Journal of Oral and Maxillofacial Surgery, 1999;57(9):1058-1065.
- Macintosh RB. The use of autogenous tissues for temporomandibular joint reconstruction. J Oral Maxillofac Surg, 2000;58:63-69.