Maxillofac Plast Reconstr Surg.  2019 ;41(1):18. 10.1186/s40902-019-0200-x.

Gap arthroplasty with active mouth opening exercises using an interocclusal splint in temporomandibular joint ankylosis patients

• Park MW
• Eo MY
• Seo BY
• Nguyen TT
• Kim SM

• KMID: 2468966
• DOI: http://doi.org/10.1186/s40902-019-0200-x

Abstract

BACKGROUND
Temporomandibular joint (TMJ) ankylosis during early childhood may lead to disturbances in growth and facial asymmetry and to serious difficulties in eating as well as in breathing during sleep. The purpose of this study is to describe the effectiveness of an interocclusal splint (IOS) for active mouth opening exercises in the treatment of TMJ ankylosis.
METHODS
A total of nine patients with 13 instances of TMJ ankylosis from 2008 to 2010 were included in this study, of which five patients were male and four patients were female. Five patients demonstrated unilateral ankylosis, while five patients showed bilateral symptoms. Ankylosed mass resection with coronoidectomy, fibrotic scar release, and resection of stylohyoid ligament calcification was performed with gap arthroplasty without an interpositional graft, and all patients were assessed for maximum mouth opening (MMO) during a mean 6.6-year follow-up period.
RESULTS
All patients were subjected to postoperative mouth opening exercises from the day of the operation with the help of an IOS, which was based on an impression taken during surgery. All patients were sufficiently comfortable moving their mandible according to the IOS's guiding plane and impingement, and satisfactory results were achieved, in which MMO was improved by 35"‰mm more than 6"‰years after surgery.
CONCLUSIONS
Complete and adequate resection of the ankylosed mass and postoperative active mouth opening exercises are essential in the treatment of TMJ ankylosis. Moreover, a more comfortable mouth opening guide and interdigitation can be achieved using an IOS, and newly organized fibrosis in the gap space between the newly made resected condylar head and temporal fossa can be suggested.

Keyword

Temporomandibular joint (TMJ) ankylosis; Gap arthroplasty; Interpositional graft; Interocclusal splint (IOS); Maximum mouth opening (MMO)

MeSH Terms

Ankylosis*
Arthroplasty*
Cicatrix
Eating
Exercise*
Facial Asymmetry
Female
Fibrosis
Follow-Up Studies
Head
Humans
Jupiter
Ligaments
Male
Mandible
Mouth*
Respiration
Splints*
Temporomandibular Joint*
Transplants