Staged Surgical Treatment for Temporomandibular Joint Ankylosis: Intraoral Distraction After Temporalis Muscle Flap Reconstruction

Abstract

The major sequence of temporomandibular joint (TMJ) ankylosis treatment includes complete resection of the ankylotic block, creation of a new joint lining with an interpositional substance, and reconstruction of the skeletal deformity. This protocol was first established by Kaban et al.1 To create a new TMJ, an interpositional graft, including a temporalis muscle transfer procedure, has been widely used to fill the bony gap after releasing the joint ankylosis. Retrognathic mandibular shape is corrected with various orthognathic surgical treatments or costochondral grafts, concomitant with or separate from joint surgery. In recent studies, mandibular distraction has been used to lengthen the retrognathic mandible of patients with TMJ ankylosis. Together with arthroplasty, distraction was regarded as an excellent alternative for treating mandibular hypoplasia and associated ankylosis in some reports.2-5 Most of the cases reported in previous articles were unilateral cases in children. In cases of adult bilateral TMJ ankylosis, more vigorous postoperative physical therapy is mandatory, and it is difficult to use mandibular growth potential to adjust the occlusion. Moreover, occlusal stability following this surgical procedure has not been fully investigated, even though there were some occlusal changes noted after interpositional grafting. We present a case of a patient with bilateral TMJ ankylosis treated by temporalis flap reconstruction and mandibular lengthening as separate, staged surgical procedures, which showed several advantages over simultaneous distraction and interpositional graft.