Management of Temporomandibular Joint Ankylosis: Benghazi Experience

Original article


Rafa A.Gehani, Galal M. S. Omami

Department of Oral and Maxillofacial Surgery of Al-Arab Medical University, Faculty of Dentistry, Benghazi, Libya

JMJ Vol.8, No.2 (Summer) 2008:109-113


Introduction: Ankylosis of the temporomandibular joint (TMJ) involves fusion of the mandibular condyle and/or coronoid process to the skull base. When it occurs in a child, it can have devastating effects on the future growth and development of the jaws and teeth. Aim of the study: To report Libyan experience in the repair of ankylosed TMJs and associated deformities. Patients and Methods: 15 patients with TMJ ankylosis and postankylotic deformity were treated between 2002 and 2006 at Al-Jala Trauma Hospital, Benghazi, Libya. Trauma was the aetiology in all the cases. Ages ranged from 3.5 to 50 years. There were 9 male and 6 female, 13 patients had unilateral ankylosis and 2 had bilateral ankylosis. Bony ankylosis was encountered in 10 patients and fibrous ankylosis in 5 patients. Two patients were treated by bilateral arthroplasty, 4 patients by unilateral arthroplasty, 4 patients by distraction osteogenesis (DO), and 5 patients treated conservatively. Eleven patients underwent blind nasal intubation, 2 with fiberoptic intubation and tracheostomy was required in 2 patients. Of the operated patients, bicoronal flap was made in 1 patient, bilateral pre-auricular incision with temporal extension in 1 patient, and unilateral pre-auricular incision in 4 patients. 4 had temporalis muscle and fascia graft and 2 had skin graft. Re-ankylosis was observed in 2 of the conservative cases. Conclusion: Operative exercise, appropriate physiotherapy and close follow-up of the patient, in addition to sufficient resection of the ankylosed bone and early postoperative exercise, play an important role in the prevention of post-operative adhesions and re-ankylosis.

Keywords: Temporomandibular joint, Ankylosis, Postankylotic facial asymmetry, Arthroplasty, Distraction osteogenesis.