Presentation on Ankylosis

7/31/2019 Presentation on Ankylosis

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CLA IFICATION OF TMJ


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CLA IFICATION OF TMJANKYLOSIS

1. FALSE ANKYLOSIS OR TRUEANKYLOSIS

2. EXTRA ARTICULAR OR INTRA

ARTICULAR 3. FIBROUS OR BONY

4. UNILATERAL OR BILATERAL

5. PARTIAL OR COMPLETE


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False ankylosis may be caused byenlargement of the coronoid process,depressed fracture of the zygomatic arch,scarring from surgery, irradiation,

infection, etc. True ankylosis of the mandible is one of

the most disturbing articular pathosis of

TMJ, causing many psychological andphysical disturbances.


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Intra-articular ankylosisindicates union between

articular surfaces of theTMJ.

Extra-articular ankylosis

results from lesionsinvolving extra articular

structures.


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Bony ankylosis- union of thebones of a joint byproliferation of bone cells,

resulting in completeimmobility

Fibrous ankylosis- reducedjoint mobility due toproliferation of fibrous tissue.


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ETIOLOGY OF TMJANKYLOSIS


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1.Trauma to the joint during an accident, fall etc

2.Trauma during birth, forceps delivery etc

3.Congenital or birth defect

4.Disease or infection in the joint, ear infection etc

5.Enlargement of the coronoid process

6.Depressed fracture of the zygomatic arch, condylar

neck fracture etc7.Surgery to or around the joint

8.Rheumatoid arthritis

9.Ankylotic conditions such as ankylosing spondylitismay also be inherited.

10.Destruction of the joint cartilage


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Signs and Symptoms ofTMJ Ankylosis

The problems that arise with the TMJ Ankylosis arepsychological, morphological, Aesthetic andfunctional. The restricted function of the joint would

affect the jaw movement.


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1.Restricted movements of the jaw,the mandible due to the condyle fusion in the TMJ

.2.Inadequate chewing function

3.Restricted mouth opening4.Poor maintenance of oral hygiene

5In severe cases, problems in speech

6.In children, reduced growth of mandible results inBird Face

7.If single side is affected, facial asymmetry is seen

8.Misaligned teeth, due to lack of enough space inthe jaws

9.Emotional, social, psychological disturbances


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Types


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RADIOGRAPHIC

FEATURESRadiographic examination is also an important part in theclinical assessment and diagnosis of the TMJ Ankylosis.Although there are no specific radiographic features seen,the joint still would show an irregularly shaped condyle ofthe mandible, and even there is a dense bone filling in thejoint space which is indicative of the restricted movementof the mandible.


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Treatment of TMJAnkylosis

Th i t t t d f th TMJ


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There are various treatment procedures for the TMJAnkylosis and this condition can be corrected usingdifferent surgical and non-surgical methods.

Excision of the Ankylosis via Gap Arthroplasty

In Gap Arthroplasty no substance isinterposedbetween the two cut bony surfaces. Section consists oftwo horizontal osteotomy cuts and the roof of theglenoid fossa and ramus. Minimum of 1 cm gap is

created to prevent reankylosis.bone is removed byusing a large round bur, until the medial bone isthinned out enough to be readily removed by usinghand chisel or osteotome.


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CONDYLECTOMY

It is advocated in cases of fibrous ankylosis, where thejoint space is obliterated with the ddeposition of fibrousbands but there is not much deformity of the condylarhead.

If the Ankylosis is intra-articular and the coronoid

process is involved, the Condylectomy is done,and if the the coronoid process along with thezygomatic arch are involved, the osteotomy ofthe coronoid process along with a part of theramus is done.


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Total condylectomy followed by the

replacement of the joint using

autogenous, alloplastic, allogenicmaterial.

If the condition is unilateral, thetreatment is not as complex as that of

the bilateral ankylosis, because thebilateral has not just the problem ofthe joint but also the development ofthe jaw and chin is affected and that

needs to be corrected.


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CORONOIDECTOMY

This is the excision of the coronoidprocess of the mandible to releasethe temporalis muscle.


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Therapeutic treatment (biphosphonates,

NSAIDS) and physiotherapy to discourage

reankylosis of the joint is very important after any

surgical corrections. Patient compliance to the

postoperative physical therapy is essential tosuccess of any surgical treatment. Jaw-opening

exercises must be performed for months to years to

maintain the normal mouth opening.


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INTERPOSITIONAL

ARTHROPLASTYIt involves the creation of a gap and a barrier isinserted between the cut bony surfaces tominimize the risk of recurrence and to maintain

the vertical height of ramus.


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Inter-positioning of the TMJ withtemporal fascia or cartilage maybedone to prevent reankylosis of thejoint. In cases of bilateral trueankylosis, the treatment is morecomplex. Facial deformity andasymmetry can be corrected by

bone grafts, distractionontogenesis, orthognathic surgery--- saggital split osteotomy,genioplasty, or Extended-sliding

genioplasty.


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Problems Associatedwith TMJ Ankylosis


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1. Restricted jaw movements

2. Inadequate masticatory (chewing) function

3. Restricted mouth opening

4. Inhibited facial and physical growth

5. Impaired speech

6. Reduced growth of mandible resulting in Bird Face

7. Facial asymmetry if only one side is affected8. Difficulty in breathing and swallowing

9. Snoring and difficulty in sleeping on lying down

10. Insufficient access for dental care resulting in

multiple decayed teeth

11.Misaligned teeth because of lack of space for theeruption of the normal component of teeth

12.Other emotional, social and psychological

disturbances

Presentation on Ankylosis

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