Silicon Interpositional Arthroplasty for Temporo-mandibular Joint Ankylosis
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ORIGINAL ARTICLE
Silicon Interpositional Arthroplasty for Temporo-mandibular Joint Ankylosis Pawan Agarwal1
•
M. P. Singh2 • Swati Tiwari1 • Dhananjaya Sharma1
Received: 14 July 2020 / Accepted: 12 August 2020 Ó Association of Otolaryngologists of India 2020
Abstract Temporo-mandibular joint (TMJ) ankylosis is characterized by a decreased mouth opening which affects mastication, speech, and facial aesthetic. Interpositional arthroplasty using autologous tissue is accepted treatment for TMJ Ankylosis; however, harvesting autologous tissue is associated with additional morbidity. In this article we report our results of silicon interpositional arthroplasty for TMJ ankylosis. 20 patients with TMJ ankylosis were included in the study. All patients underwent standard operative procedure using preauricular incision for release of TMJ ankylosis by excision of at least 1 cm of bony block and insertion of 2 cm thick silicon block in the joint space. Postoperatively early mobilization of TMJ was advised from 3rd day onwards. Post operative result was evaluated by assessing the mouth opening as inter incisor distance (IID). 20 patients (27 joints) of TMJ ankylosis were included in the study. There were 8 male and 12 female patients with age ranged from 3–35 years. According to Sawhney classification bony ankylosis was present as Type-IV (n = 13 joints), Type-III (n = 12 joints) and Type-II (2 joints). Preoperative mean IID was 7.15 mm and post operative mean IID was 43.5. There was no facial nerve paresis, malocclusion or recurrence but infection and extrusion of implant occurred in 1 case each. Silicon interpositional arthroplasty is an effective procedure for the treatment of TMJ Ankylosis; as it restores mouth opening
& Pawan Agarwal [email protected] 1
Department of Surgery, NSCB Government Medical College, Madhya Pradesh, Jabalpur 482003, India
2
Maxillofacial Surgeon Aditiya Hospital, Madhya Pradesh, Jabalpur 482001, India
and function, maintains the vertical ramus height, and prevents re-ankylosis without any donor site morbidity. Keywords Temporo-mandibular joint ankylosis Trismus Silicon interpositional arthroplasty
Introduction Temporo-mandibular joint (TMJ) ankylosis is characterized by a decreased mouth opening which affects mastication, speech, facial aesthetic, oral hygiene and results in psycho-social problems. Apart from these problems TMJ paediatric ankylosis leads to disturbances of facial growth, and sleep apnoea [1]. TMJ ankylosis is mainly caused by trauma (condylar fracture), infection (otitis media and mastoiditis), arthritis, previous TMJ surgery and rarely, systemic diseases like rheumatoid arthritis/psoriasis or ankylosing spondylitis [2–4]. Diverse surgical techniques for treatment of TMJ ankylosis with their outcomes have been reported however, there is no consensus regarding ideal treatment for TMJ ankylosis. Interpositional arthroplasty using autologous tissue is accepted treatment for TMJ ankylosis however harvesting autologous tissue is associated with additional donor sit
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