Gap arthroplasty with active mouth opening exercises by interocclusal splint in the temporomandibular joint ankylosis

Abstract

Purpose: Temporomandibular joint (TMJ) ankylosis might include fibrous or bony adhesions in the TMJ that limit functional opening. The etiologies include trauma, arthritis, infection, previous TMJ surgery, congenital and idiopathic. TMJ ankylosis during early childhood may lead to disturbances in growth and facial asymmetry and to serious difficulties in eating and breathing during sleep. The purpose of this study is to describe effectiveness of interocclusal splint (IOS) for the active mouth opening exercises in the treatment of TMJ ankylosis.

Materials and Methods: Total nine patients with thirteen TMJ ankylosis from 2008 to 2010 are included in this study, of which 5 patients are male and 4 patients are female. 5 patients are unilateral and 4 patients are bilateral ankylosis. Ankylotic mass resection with coronoidectomy, fibrotic scar releasing, resection of stylohyoid ligament calcification were performed with gap arthroplasty without interpositional graft, and all patients were assessed for maximum mouth opening (MMO) during a mean 31.4 months.

Results: All patients are subjected to postoperative mouth opening exercises from the right operation day with the help of IOS which was made after taking an impression during operation. All patients are comfortable to move their mandible according to IOS's guiding plane and impingement, and there are satisfactory results of which MMO is more than 35 mm more than two years after operation.

Conclusions: Complete and adequate resection of ankylotic mass and postoperative active mouth opening exercises is essential in treatment of TMJ ankylosis. More than this, we can acquire more comfortable mouth opening guide and interdigitation by using of IOS, and newly organized fibrosis in the gap space between newly made resected condylar head and temporal fossa can be suggested.