Selecting Reconstruction Option for TMJ Ankylosis: A Surgeon's Dilemma

Objectives: The aim of this study was to compare the outcome of reconstruction options adopted for the management of temporomandibular joint (TMJ) ankylosis. Patients and Methods: This retrospective cohort study consisted of a sample of patients with TMJ ankylosis diagnosed clinically and radiologically. Depending upon the reconstruction provided, the cases were divided into 2 groups. Group I includes the cases treated by excision of ankylosed mass and interposition of temporalis myofascial flap. In group II, the cases were treated by excision, temporalis myofascial flap interposition, and reconstruction of ramus condylar unit (RCU). Two different methods of reconstruction were used, costochondral graft (CCG) (group IIa) and distraction osteogenesis (group IIb). The outcome variables were range of jaw motion, overgrowth of CCG, reankylosis, and other complications. Data analyses included appropriate univariate and bivariate statistics. Results: The average mouth opening achieved in both groups was 36 mm. Failure was observed in 3 patients, 1 from group I and 2 from group IIa. One case of bilateral ankylosis and 2 cases of unilateral ankylosis had recurrence. No overgrowth of CCG was observed. Conclusions: In cases with no or minimal mandibular deformity, interpositional arthroplasty with temporalis myofascial flap is a good option without a second surgical wound. However, in younger patients, joint reconstruction with both costochondral graft and distraction osteogenesis of RCU is more appropriate and had similar results. The failure of treatment was due to noncompliance to postsurgical physiotherapy rather than the selection of reconstruction options.