Abdominal Dermis-Fat Graft Versus Conventional Temporalis Myofascial Flap Interposition in Temporomandibular Joint Ankyl
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COMPARATIVE STUDY
Abdominal Dermis-Fat Graft Versus Conventional Temporalis Myofascial Flap Interposition in Temporomandibular Joint Ankylosis: A Prospective Clinical Comparative Study Mubashir Younis1 • Ajaz Ahmed Shah2 • Shahid Hassan2 • Muneet Kapoor2 Abina Rashid3
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Received: 13 July 2020 / Accepted: 25 September 2020 Ó The Association of Oral and Maxillofacial Surgeons of India 2020
Abstract Introduction Temporomandibular joint (TMJ) ankylosis is an extremely disabling condition with almost complete inability to open the jaws causing difficulty in chewing, speech, poor oral hygiene and cosmetic disfigurement. Temporalis myofascial flap still remains the most common interpositional material used; however, patients usually complain of pain during movement, unesthetic bulging in the temporal region and trismus due to scar contracture. The main aim of the study was to evaluate the efficacy of abdominal dermis-fat graft and compare it with temporalis myofascial flap as to see which of the two grafts offers more advantages and provides better postoperative results following TMJ ankylosis surgery. Materials and Methods A total of 30 diagnosed cases of TMJ ankylosis were randomly divided into two groups of 15 patients each. All the patients underwent TMJ ankylosis release under general anesthesia followed by abdominal dermis-fat interposition in Group A and temporalis muscle in Group B. The patients were assessed for pre-operative and postoperative mouth opening (immediate and 6 month postoperative), pain during physiotherapy, donor and surgical site complications and recurrence of ankylosis.
Results The mean maximum inter-incisal opening in dermis-fat group was significantly higher than temporalis group both at immediate and 6 month postoperative periods (p = 0.041, 0.001). Physiotherapy was less painful in dermis-fat group than in temporalis group, and the differences in VAS scores among the 2 groups showed high statistical significance (p \ 0.001). Hypertrophic scar developed at the donor site in 2 patients in dermis-fat group; however, it was located below the beltline and hardly noticeable. A total of 9 patients (4 in Group A and 5 in Group B) developed temporary facial nerve weakness, and no case of re-ankylosis was noted in either group. Conclusion Dermis-fat graft in temporomandibular joint ankylosis showed better results than conventional temporalis myofascial flap in terms of postoperative mouth opening, physiotherapy and jaw function with esthetically acceptable results. Keywords Temporomandibular joint ankylosis Temporalis myofascia Dermis fat Physiotherapy Facial nerve
Introduction & Mubashir Younis [email protected] 1
Department of Oral and Maxillofacial Surgery, Elite Mission Hospital, Thrissur, Kerala, India
2
Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital Srinagar, Srinagar, Jammu and Kashmir, India
3
SKIMS Medical College and Hospital, Srinagar, Jammu and Kashmir, India
Ankylosis is a Greek term meaning ‘‘stiff joint’’ and refers to ab
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