1
Treatment of Ankylosis
of Temporomandibular Joint
Definition,intra-articular and extra-articular processes may restrict jaw
motion severely,Ankylosis of the TMJ is an intra-articular process
characterized by fibrous,fibro-osseous,or osseous obliteration(消失 )
of the joint space,Extracapsular causes of restricted jaw motion
(pseudoankylosis) include but are not limited to coronoid-zygomatic
fusion(融合 ),coronoid hypertropy,and muscular fibrosis,
2
Indications for therapy for ankylosis
(may include one or more of the following)
Severely restricted jaw motion accompanied by one or more
of the following,
?Inadequate masticatory function
?Abnormal speech
?Inability to undergo dental and /or medical care
?Compromised anesthetic management
?Inhibited facial growth
?Imaging evidence of osseous or soft tissue abnormality
3
A,Presence of a general therapeutic goal
B,Release of ankylosis
C,Access for dental and/or medical care
D,Improved speech
E,Improved masticatory function
F,Relief or reduction of pain
Specific Therapeutic Goals for Ankylosis
(The goal of therapy is to restore form and/or function,However,risk
factors and potential complications may preclude(妨碍 ) complete
restoration of form and/or function)
4
Specific Factor Affecting Risk for Ankylosis
(Severity factors that increase risk and the potential for known complications)
A,Presence of a general factor effecting risk
B,Type of ankylosis (ie,fibrous or bony)
C,Etiology of the ankylosis (eg,traumatic or inflammatory)
D,Extent and duration of ankylosis
E,Degree of pre-existing muscular atrophy
F,Ankylosis in a growing child
5
Indicated therapeutic standards for ankylosis
1,General history and physical examination
2,Focused history and physical examination of the TMJ region
to region to determine the presence of indications for care of
ankylosis and to identify factors affecting risks
3,An imaging examination,if indicated,based on the history and
physical findings,The examination may include but is not
limited to,panoramic radiograph,cephalometric radiograph,
conventional tomogram,CT scan,and/or MRI
The pretreatment assessment includes,
6
Post-treatment management
1,Wound care
2,Pain management
3,Diet and oral hygiene(卫生 ) management
4,Occlusal management
5,Physical therapy
6,Appropriate diagnostic records to determine progression
of the disease
7,Patient reassessment
8,Instruction for post-treatment care and follow-up
7
Arthroscopic surgery (early stage of fibrous ankylosis)
Open surgery (most)
? Arthroplasty
? Condylectomy,partical or total and +/- replacement
(eg,total joint prosthesis,costochondral graft)
? Gap arthroplasty +/- autogenous or alloplastic or allogeneic
interposition (my favor,temporal fascia or auricular cartilage)
? Coronoidectomy or cononoidotomy (often)
? Orthognathic surgery for residual maxillofacial deformity
pseudoankylosis
? Osteotomy of zygoma or zygomatic arch
? Myotomy
? Coronoidectomy or cononoidotomy
? Scar revision (eg,intraoral and /or extraoral)
(adjacent tissue transfer)
Management
fibrous,fibro-osseous,or osseous ankylosis
8
Diagnoses
Arthroscopic surgery
9
Treatment
10
Adhesion between eminence & disc
CASE REPORT F 33
PREOPERATION
POSTOPERATION
11
CASE REPORT M 40
CHRONIC SEPTIC ARTHRITIS WITH INFECTION OF INFRATEMPORAL
SPACE AFTER EXTRACTION OF TEETH
Duration 2m
Gran’s stain Bacteria culture
12
Open Surgery
(focus on ankylosis)
? Removal of bony tissue on medial aspect of the TMJ
? Release of soft tissue in the peri-articular regions
(etiology of ankylosis is inflammatory)
Important procedures
13
Gap arthroplasty with
auricular cartilage
interposition
Case 1,Fibrous-osseous ankylosis
14
Gap arthroplasty auricular cartilage interposition
Fibrous-osseous ankylosis
15
Case 2,osseous ankylosis
(recurrent case)
Arthroplasty with
temporal fascia graft interposition
16
Case 3,osseous ankylosis
costochondral graft replacement
17
Remove lateral osseous ankylosis with remaining medial condyle,disk,and fossa
Case 4
The condylar neck stump(残余部分 )
is ankylosed to the fossa while the
medially displaced fracture condyle
is ankylosed to the anteromedial
aspect of condylar stump
18
Case 5,osseous ankylosis
? Ankylosis
? Maxillofacial deformity
? OSAS
Orthognathic surgery for
residual maxillofacial deformity
19
20
21
22
23
Case 6
24
4 mo
25
Case 7 release of ankylosis
double jaws osteotomy
26
Distraction osteogenesis,
DO
For prolonging mandible body
27
术前 术后
Case 8
28
定制式人工关节 1
Customized TMJ Implant
29
30
pseudoankylosis
31
Osseous fusion between medial aspect with Pterygoid process of sphenoid bone
32
osteotomy
33
Masseter muscle fibrosis
（ scar）
T m
Myotomy
cononoidotomy
34
Co hypertrophy
Coronoidectomy
35
Zygomatic bone fracture
36
Treatment of Ankylosis
of Temporomandibular Joint
Definition,intra-articular and extra-articular processes may restrict jaw
motion severely,Ankylosis of the TMJ is an intra-articular process
characterized by fibrous,fibro-osseous,or osseous obliteration(消失 )
of the joint space,Extracapsular causes of restricted jaw motion
(pseudoankylosis) include but are not limited to coronoid-zygomatic
fusion(融合 ),coronoid hypertropy,and muscular fibrosis,
2
Indications for therapy for ankylosis
(may include one or more of the following)
Severely restricted jaw motion accompanied by one or more
of the following,
?Inadequate masticatory function
?Abnormal speech
?Inability to undergo dental and /or medical care
?Compromised anesthetic management
?Inhibited facial growth
?Imaging evidence of osseous or soft tissue abnormality
3
A,Presence of a general therapeutic goal
B,Release of ankylosis
C,Access for dental and/or medical care
D,Improved speech
E,Improved masticatory function
F,Relief or reduction of pain
Specific Therapeutic Goals for Ankylosis
(The goal of therapy is to restore form and/or function,However,risk
factors and potential complications may preclude(妨碍 ) complete
restoration of form and/or function)
4
Specific Factor Affecting Risk for Ankylosis
(Severity factors that increase risk and the potential for known complications)
A,Presence of a general factor effecting risk
B,Type of ankylosis (ie,fibrous or bony)
C,Etiology of the ankylosis (eg,traumatic or inflammatory)
D,Extent and duration of ankylosis
E,Degree of pre-existing muscular atrophy
F,Ankylosis in a growing child
5
Indicated therapeutic standards for ankylosis
1,General history and physical examination
2,Focused history and physical examination of the TMJ region
to region to determine the presence of indications for care of
ankylosis and to identify factors affecting risks
3,An imaging examination,if indicated,based on the history and
physical findings,The examination may include but is not
limited to,panoramic radiograph,cephalometric radiograph,
conventional tomogram,CT scan,and/or MRI
The pretreatment assessment includes,
6
Post-treatment management
1,Wound care
2,Pain management
3,Diet and oral hygiene(卫生 ) management
4,Occlusal management
5,Physical therapy
6,Appropriate diagnostic records to determine progression
of the disease
7,Patient reassessment
8,Instruction for post-treatment care and follow-up
7
Arthroscopic surgery (early stage of fibrous ankylosis)
Open surgery (most)
? Arthroplasty
? Condylectomy,partical or total and +/- replacement
(eg,total joint prosthesis,costochondral graft)
? Gap arthroplasty +/- autogenous or alloplastic or allogeneic
interposition (my favor,temporal fascia or auricular cartilage)
? Coronoidectomy or cononoidotomy (often)
? Orthognathic surgery for residual maxillofacial deformity
pseudoankylosis
? Osteotomy of zygoma or zygomatic arch
? Myotomy
? Coronoidectomy or cononoidotomy
? Scar revision (eg,intraoral and /or extraoral)
(adjacent tissue transfer)
Management
fibrous,fibro-osseous,or osseous ankylosis
8
Diagnoses
Arthroscopic surgery
9
Treatment
10
Adhesion between eminence & disc
CASE REPORT F 33
PREOPERATION
POSTOPERATION
11
CASE REPORT M 40
CHRONIC SEPTIC ARTHRITIS WITH INFECTION OF INFRATEMPORAL
SPACE AFTER EXTRACTION OF TEETH
Duration 2m
Gran’s stain Bacteria culture
12
Open Surgery
(focus on ankylosis)
? Removal of bony tissue on medial aspect of the TMJ
? Release of soft tissue in the peri-articular regions
(etiology of ankylosis is inflammatory)
Important procedures
13
Gap arthroplasty with
auricular cartilage
interposition
Case 1,Fibrous-osseous ankylosis
14
Gap arthroplasty auricular cartilage interposition
Fibrous-osseous ankylosis
15
Case 2,osseous ankylosis
(recurrent case)
Arthroplasty with
temporal fascia graft interposition
16
Case 3,osseous ankylosis
costochondral graft replacement
17
Remove lateral osseous ankylosis with remaining medial condyle,disk,and fossa
Case 4
The condylar neck stump(残余部分 )
is ankylosed to the fossa while the
medially displaced fracture condyle
is ankylosed to the anteromedial
aspect of condylar stump
18
Case 5,osseous ankylosis
? Ankylosis
? Maxillofacial deformity
? OSAS
Orthognathic surgery for
residual maxillofacial deformity
19
20
21
22
23
Case 6
24
4 mo
25
Case 7 release of ankylosis
double jaws osteotomy
26
Distraction osteogenesis,
DO
For prolonging mandible body
27
术前 术后
Case 8
28
定制式人工关节 1
Customized TMJ Implant
29
30
pseudoankylosis
31
Osseous fusion between medial aspect with Pterygoid process of sphenoid bone
32
osteotomy
33
Masseter muscle fibrosis
（ scar）
T m
Myotomy
cononoidotomy
34
Co hypertrophy
Coronoidectomy
35
Zygomatic bone fracture
36
