Ankylosis is a Greek terminology meaning ‘stiff joint’.Here because of immobility of the joint, the jaw functiongets affected. Hypomobility to immobility of the jointcan lead to inability to open the mouth from partial to complete.

Classification of ankylosis1-False or True2-Extra-articular or intra articular3-Fibrous or bony4-Unilateral or Bilteral5-Partial or Complete

Kaban’s Protocol 19901-Early surgical intervention2-Aggressive resection3-Ipsilateral coronoidectomy & temporalis myotomy4-Contralateral coronoidectomy & temporalis myotomy if incisal opening less than 35 mm.5-Lining of glenoid fossa with temporalis fascia6-Reconstruction of ramus using distraction osteogenesis,when possible, instead of costochondral grafting7-Early mobilization & aggressive physiotherapy8-Long term follow up & cosmetic surgery at later stage

Condylectomy Gap arthroplasty Interpositional arthroplasty

Unilateral Ankylosis

Bilateral Ankylosis

Clinical Features

MANAGEMENT OF TMJ ANKYLOSISSurgical Management

Complication of SurgeryIntraoperative•Hemorrhage•Damage to external auditory meatus•Damage to zygomatic & temporal br. Of facial nerve•Damage to auriculotemporal nerve•Damage to parotid glandPostoperative•Infection •Open bite

Radiologic features

Recurrence of TMJ ankylosis1-An inadequate gap created btn fragments2-Fracture of the costochondral graft3-Inadequate coverage of glenoid fossa surface4-Inadequate postoperative physiotherapy5-Loosening of costochondral graft

Advocated in case of fibrous ankylosisPre-auricular incision is made Horizontal osteotomy cut at the level of condylar neck with surgical burThe condylar head is separated from the superior attachment carefully

Advocated in extensive bony ankylosisThe section consists of two horizontal osteotomy cutsRemoval of a bony wedge for creation of a gap between the roof of glenoid fossa & ramus

creation of gap but in addition a barrier is inserted /Materials are used to interpose between ramus & base of the skull to avoid re-ankylosis & to maintain vertical height of ramus.

Fibrous Ankylosis

Bony Ankylosis

Surgical approaches to mandibular condyle

Post Auricular approach Lamport’s Endaural Approach Submandibular Approach Postramal IncisionPreauricular Iccision Alkayat & Bramley’s Incision