Imaging Sci Dent.  2015 Jun;45(2):103-108. 10.5624/isd.2015.45.2.103.

Severe bony ankylosis of the temporomandibular joint on one side and contralateral adhesion: A case report

• Song JY
• Kim SG
• Choi HM
• Kim HJ

• KMID: 2054212
• DOI: http://doi.org/10.5624/isd.2015.45.2.103

Abstract

Bony fusion between the mandibular condyle and skull base involves temporomandibular joint (TMJ) bony ankylosis. This condition might originate from trauma, infection, or systemic disease. TMJ adhesion can develop after synovial damage. Both TMJ ankylosis and adhesion lead to functional impairment and pain. Here, we present a case of a 50-year-old female who had bony ankylosis of the right TMJ and adhesion of the left TMJ. She had otitis media in the right ear. A large mass in the right TMJ was observed on computed tomograph. Magnetic resonance image showed a large fused bone mass with normal bone marrow in the right TMJ and flattening of the condyle with a thin disk in the left TMJ. Gap arthroplasty with temporal fascia was performed on the right TMJ, and discectomy, high condylectomy, and coronoidectomy were performed on the left TMJ. During a 2-year follow-up after surgery, the patient had no recurrence.

Keyword

Temporomandibular Joint; Ankylosis; Arthroplasty; Mouth Rehabilitation

MeSH Terms

Ankylosis*
Arthroplasty
Bone Marrow
Diskectomy
Ear
Fascia
Female
Follow-Up Studies
Humans
Mandibular Condyle
Middle Aged
Mouth Rehabilitation
Otitis Media
Recurrence
Skull Base
Temporomandibular Joint*

Figure

• 

  Fig. 1 Panoramic radiograph shows bony ankylosis of the right temporomandibular joint (TMJ) and normal outline of the left TMJ.

• 

  Fig. 2 Axial (A) and coronal (B) computed tomographic (CT) images show bony ankylosis of the right TMJ and articular space of the left TMJ clearly revealed by CT.

• 

  Fig. 3 T1-weighted sagittal (A) and coronal (B) magnetic resonance (MR) images reveal a large fused bone mass in the right TMJ.

• 

  Fig. 4 T1-weighted sagittal (A) and coronal (B) MR images show the flattening of the condyle with a thin disk in the left TMJ.

• 

  Fig. 5 Photographs of three-dimensional rapid prototyping model. A. The right condyle is fused with the posterior portion of the zygomatic arch. Abnormal bone formation is also detected in and around the TMJ. B. Narrowed articular space is detected in the left TMJ.

• 

  Fig. 6 Panoramic radiograph shows that the patient underwent dental implant surgery 3 months after the surgery.

• 

  Fig. 7 Photograph shows performing full mouth rehabilitation 4 months after surgery.

• 

  Fig. 8 The patient maintains a maximum mouth opening of approximately 20 mm 2 years after surgery.

Reference

1. McFadden LR, Rishiraj B. Treatment of temporomandibular joint ankylosis: a case report. J Can Dent Assoc. 2001; 67:659–663.

2. Li JM, An JG, Wang X, Yan YB, Xiao E, He Y, et al. Imaging and histologic features of traumatic temporomandibular joint ankylosis. Oral Surg Oral Med Oral Pathol Oral Radiol. 2014; 118:330–337.

3. Casanova MS, Tuji FM, Ortega AI, Yoo HJ, Haiter-Neto F. Computed tomography of the TMJ in diagnosis of ankylosis: two case reports. Med Oral Patol Oral Cir Bucal. 2006; 11:E413–E416.

4. El-Hakim IE, Metwalli SA. Imaging of temporomandibular joint ankylosis. A new radiographic classification. Dentomaxillofac Radiol. 2002; 31:19–23.

5. Manganello-Souza LC, Mariani PB. Temporomandibular joint ankylosis: report of 14 cases. Int J Oral Maxillofac Surg. 2003; 32:24–29.

6. Chidzonga MM. Temporomandibular joint ankylosis: review of thirty-two cases. Br J Oral Maxillofac Surg. 1999; 37:123–126.

7. Bhatt K, Roychoudhury A, Balakrishnan P. Temporomandibular joint ankylosis: is hypercoagulable state of blood a predisposing factor? Med Hypotheses. 2013; 81:561–563.

8. Kaminishi RM, Davis CL. Temporomandibular joint arthroscopic observations of superior space adhesions. Oral Maxillofac Surg Clin North Am. 1989; 1:103–109.

9. Sanromán JF. Closed lock (MRI fixed disc): a comparison of arthrocentesis and arthroscopy. Int J Oral Maxillofac Surg. 2004; 33:344–348.

10. Shinohara Y, Okamoto K, Goh Y, Kiga N, Tojyo I, Fujita S. Inhibition of fibrous adhesion formation in the temporomandibular joint of tenascin-C knockout mice. Eur J Histochem. 2014; 58:2337.

11. Sheets DW Jr, Okamoto T, Dijkgraaf LC, Milam SB, Schmitz JP, Zardeneta G. Free radical damage in facsimile synovium: correlation with adhesion formation in osteoarthritic TMJs. J Prosthodont. 2006; 15:9–19.

12. More CB, Gupta S. Osteochondroma of mandibular condyle: a clinic-radiographic correlation. J Nat Sci Biol Med. 2013; 4:465–468.

13. Sporniak-Tutak K, Janiszewska-Olszowska J, Kowalczyk R. Management of temporomandibular ankylosis - compromise or individualization - a literature review. Med Sci Monit. 2011; 17:RA111–RA116.

14. Sales MA, Oliveira JX, Cavalcanti MG. Computed tomography imaging findings of simultaneous bifid mandibular condyle and temporomandibular joint ankylosis: case report. Braz Dent J. 2007; 18:74–77.

15. Zhang S, Liu X, Yang C, Cai X, Chen M, Haddad MS, et al. Intra-articular adhesions of the temporomandibular joint: relation between arthroscopic findings and clinical symptoms. BMC Musculoskelet Disord. 2009; 10:70.

16. Roychoudhury A, Parkash H, Trikha A. Functional restoration by gap arthroplasty in temporomandibular joint ankylosis: a report of 50 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999; 87:166–169.

17. Vasconcelos BC, Bessa-Nogueira RV, Cypriano RV. Treatment of temporomandibular joint ankylosis by gap arthroplasty. Med Oral Patol Oral Cir Bucal. 2006; 11:E66–E69.

18. Felstead AM, Revington PJ. Surgical management of temporomandibular joint ankylosis in ankylosing spondylitis. Int J Rheumatol. 2011; 2011:854167.

19. Rajan R, Reddy NV, Potturi A, Jhawar D, Muralidhar PV, Reddy B. Gap arthroplasty of temporomandibular joint ankylosis by transoral access: a case series. Int J Oral Maxillofac Surg. 2014; 43:1468–1472.