J Korean Assoc Oral Maxillofac Surg.  2019 Jun;45(3):129-134. 10.5125/jkaoms.2019.45.3.129.

Lateral arthroplasty along with buccal fat pad inter-positioning in the management of Sawhney type III temporomandibular joint ankylosis

• Malhotra V
• Singh V
• Rao JD
• Yadav S
• Gupta P
• Shyam R
• Kirti S

• KMID: 2451319
• DOI: http://doi.org/10.5125/jkaoms.2019.45.3.129

Abstract

OBJECTIVES
The objective of this study was to highlight the role of lateral arthroplasty along with interposition of the buccal fat pad (BFP) in the management of Sawhney type III temporomandibular joint (TMJ) ankylosis.
MATERIALS AND METHODS
Ten patients with TMJ ankylosis (7 unilateral and 3 bilateral, total of 13 joints) were treated with lateral arthroplasty and BFP interposition. The bony bridge of the ankylotic mass on the lateral aspect was resected, leaving a distance of 1.5 to 2.0 cm from the base of the skull to the neck of the condyle. The condyle was left intact. Coronoidectomy was performed on the ipsilateral side via the same approach in all cases. The inter-incisal opening was measured at that time, and if it was less than 35 mm, contralateral coronoidectomy was performed by using the intra-oral approach. After satisfactory inter-incisal mouth opening (≥35 mm) was achieved, the TMJ surgical site was revisited, and BFP was retrieved and used to cover the lateral aspect of the medially placed condyle.
RESULTS
With lateral arthroplasty, the medially displaced condyle can be left in-situ to maintain the mandibular ramal height and function and to act as a growth center in children. Interposition of the BFP prevents reformation of the lateral bony bridge that was removed.
CONCLUSION
Lateral arthroplasty along with interpositioning of the BFP is a novel technique for managing Sawhney type III ankylosis that achieves management goals while avoiding complex and advanced reconstructive surgical procedures.

Keyword

Temporomandibular joint ankylosis; Lateral arthroplasty; Buccal fat pad; Sawhney type III ankylosis

MeSH Terms

Adipose Tissue*
Ankylosis*
Arthroplasty*
Child
Humans
Mouth
Neck
Reconstructive Surgical Procedures
Skull
Temporomandibular Joint*

Figure

• 

  Fig. 1 A. Preoperative coronal cone-beam computed tomography image showing Sawhney type III ankylosis. B. Sawhney type III TMJ ankylosis.

• 

  Fig. 2 A. Postoperative coronal cone-beam computed tomography image showing lateral arthroplasty. B. Gap created after removal of lateral bony bridge.

• 

  Fig. 3 Intraoperative photograph showing medially preserved condyle (arrow).

• 

  Fig. 4 A. Intraoperative photograph showing buccal fat pad (BFP) interpositioning (arrow). B. BFP inserted on lateral aspect of condyle.

Reference

1. Sawhney CP. Bony ankylosis of the temporomandibular joint: follow-up of 70 patients treated with arthroplasty and acrylic spacer interposition. Plast Reconstr Surg. 1986; 77:29–40.

2. Nitzan DW, Bar-Ziv J, Shteyer A. Surgical management of temporomandibular joint ankylosis type III by retaining the displaced condyle and disc. J Oral Maxillofac Surg. 1998; 56:1133–1138. discussion 1139.

3. Loveless TP, Bjornland T, Dodson TB, Keith DA. Efficacy of temporomandibular joint ankylosis surgical treatment. J Oral Maxillofac Surg. 2010; 68:1276–1282.

4. Mehrotra D, Pradhan R, Mohammad S, Kumar S. Complications associated with different surgical modalities for management of temporomandibular ankylosis in a series of 791 cases. Asian J Oral Maxillofac Surg. 2011; 23:122–127.

5. Zhi K, Ren W, Zhou H, Gao L, Zhao L, Hou C, et al. Management of temporomandibular joint ankylosis: 11 years' clinical experience. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009; 108:687–692.

6. Elgazzar RF, Abdelhady AI, Saad KA, Elshaal MA, Hussain MM, Abdelal SE, et al. Treatment modalities of TMJ ankylosis: experience in Delta Nile, Egypt. Int J Oral Maxillofac Surg. 2010; 39:333–342.

7. Dimitroulis G. The interpositional dermis-fat graft in the management of temporomandibular joint ankylosis. Int J Oral Maxillofac Surg. 2004; 33:755–760.

8. Singh V, Bhagol A, Dhingra R, Kumar P, Sharma N, Singhal R. Management of temporomandibular joint ankylosis type III: lateral arthroplasty as a treatment of choice. Int J Oral Maxillofac Surg. 2014; 43:460–464.

9. Braimah R, Taiwo A, Ibikunle A, Oladejo T, Adeyemi M, Adejobi F, et al. Clinical experience in managing temporomandibular joint ankylosis: five-year appraisal in a Nigerian subpopulation. J Korean Assoc Oral Maxillofac Surg. 2018; 44:112–119.

10. Harvold EP, Vargervik K, Chierici G. Treatment of hemifacial microsomia. New York: A.R. Liss;1983.

11. Caldwell JB. Surgical management of temporomandibular joint ankylosis in children. Int J Oral Surg. 1978; 7:354–359.

12. Egyedi P. Utilization of the buccal fat pad for closure of oro-antral and/or oro-nasal communications. J Maxillofac Surg. 1977; 5:241–244.

13. Messenger KL, Cloyd W. Traumatic herniation of the buccal fat pad. Report of a case. Oral Surg Oral Med Oral Pathol. 1977; 43:41–43.

14. Wolford DG, Stapleford RG, Forte RA, Heath M. Traumatic herniation of the buccal fat pad: report of case. J Am Dent Assoc. 1981; 103:593–594.

15. Scott P, Fabbroni G, Mitchell DA. The buccal fat pad in the closure of oro-antral communications: an illustrated guide. Dent Update. 2004; 31:363–364. 366

16. Singh J, Prasad K, Lalitha RM, Ranganath K. Buccal pad of fat and its applications in oral and maxillofacial surgery: a review of published literature (February) 2004 to (July) 2009. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010; 110:698–705.

17. Rattan V. A simple technique for use of buccal pad of fat in temporomandibular joint reconstruction. J Oral Maxillofac Surg. 2006; 64:1447–1451.

18. Xiao H, Bayramiçli M, Jackson IT. Volumetric analysis of the buccal fat pad. Eur J Plast Surg. 1999; 22:177–180.

19. Baumann A, Ewers R. Application of the buccal fat pad in oral reconstruction. J Oral Maxillofac Surg. 2000; 58:389–392.

20. Adeyemo WL, Ogunlewe MO, Ladeinde AL, James O. Closure of oro-antral fistula with pedicled buccal fat pad. A case report and review of literature. Afr J Oral Health. 2004; 1:42–46.

21. Colella G, Tartaro G, Giudice A. The buccal fat pad in oral reconstruction. Br J Plast Surg. 2004; 57:326–329.

22. Chakrabarti J, Tekriwal R, Ganguli A, Ghosh S, Mishra PK. Pedicled buccal fat pad flap for intraoral malignant defects: a series of 29 cases. Indian J Plast Surg. 2009; 42:36–42.

23. Chien CY, Hwang CF, Chuang HC, Jeng SF, Su CY. Comparison of radial forearm free flap, pedicled buccal fat pad flap and splitthickness skin graft in reconstruction of buccal mucosal defect. Oral Oncol. 2005; 41:694–697.

24. Liu YM, Chen GF, Yan JL, Zhao SF, Zhang WM, Zhao S, et al. Functional reconstruction of maxilla with pedicled buccal fat pad flap, prefabricated titanium mesh and autologous bone grafts. Int J Oral Maxillofac Surg. 2006; 35:1108–1113.

25. Singh V, Dhingra R, Sharma B, Bhagol A, Kumar P. Retrospective analysis of use of buccal fat pad as an interpositional graft in temporomandibular joint ankylosis: preliminary study. J Oral Maxillofac Surg. 2011; 69:2530–2536.

26. Gagnani SP, Agarwal B, Bhutia O, Roychoudhury A. New method of harvesting a buccal fat pad for interposition after gap arthroplasty of the temporomandibular joint. Br J Oral Maxillofac Surg. 2016; 54:469–470.

27. Gaba S, Sharma RK, Rattan V, Khandelwal N. The long-term fate of pedicled buccal pad fat used for interpositional arthroplasty in TMJ ankylosis. J Plast Reconstr Aesthet Surg. 2012; 65:1468–1473.