Gap arthroplasty combined with physical therapy in the treatment of temporomandibular joint ankylosis

Abstract

To describe a simple and efficacious surgical technique in the treatment of TMJ ankylosis, namely gap arthroplasty and to emphasize the role of physical therapy after surgery. Design: Clinical documentation, operation notes and post-operative follow up of TMJ ankylosis cases which were operated by using the gap arthroplasty without interposition of any materials. Setting: Oral and maxillofacial surgery division of the College of Dentistry, King Saud University, Riyadh, Saudi Arabia. Subject: Ten cases of TMJ ankylosis operated by using gap arthroplasty and without interposition of any materials. Results: In all cases, gap arthroplasty was used without interposition of any materials. Physical therapy began from the second post-operative day after intraoperative initial manipulation of mandible following joint release. Within 8 weeks of the operation, mandibular range of motion improved remarkably and an average 40-50 mm interincisal distance achieved. There were no intraoperative or postoperative complications and the mouth-opening has remained, without tendency to relapse, for the past four years. Conclusions: Gap arthroplasty is a simple, yet efficacious surgical procedure for the release of the ankylosis of temporomandibular joint. It assessed the preservation of some remnants of the condylar head and maintained the functional matrix. Nevertheless, it does not by itself bring about a satisfactory result and the importance in post-operative management is the opening exercise of the mandible for at least 6 months after surgery.