Three Dimensional Morphological Grading of Ankylosed TMJ for Surgical Planning: A Retrospective Observational Study
Introduction: Temporomandibular Joint (TMJ) ankylosis remains an enigma in craniofacial surgery due to the challenges encountered while restoring mouth opening, facial form and airway to normalcy. Though TMJ ankylosis is a relatively simple diagnosis to make, the specific surgical plan depends o...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
| Published: |
JCDR Research and Publications Private Limited
2022-02-01
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| Series: | Journal of Clinical and Diagnostic Research |
| Subjects: | |
| Online Access: | https://jcdr.net/articles/PDF/15942/50424_CE[Ra1]_F[SH]_PF1(AKA_SS)_PFA(AKA_KM)_PN(KM).pdf |
| Summary: | Introduction: Temporomandibular Joint (TMJ) ankylosis remains
an enigma in craniofacial surgery due to the challenges encountered
while restoring mouth opening, facial form and airway to normalcy.
Though TMJ ankylosis is a relatively simple diagnosis to make,
the specific surgical plan depends on the nature and extent of the
fusion of the mandible with the cranial base.
Aim: To classify the pattern of bone deformity found in TMJ
ankylosis using three Dimensional (3D) Computed Tomography
(CT) imaging and its role in determining the type of procedures
required for effective gap arthroplasty.
Materials and Methods: This retrospective study was done
to evaluate the 3D CT reconstructed images of 66 consecutive
patients having 82 ankylosed joints treated from January 2007 to
December 2019 with a standardised protocol. A grading system
was used with the following criteria: coronoid hyperplasia, sigmoid
notch to skull-base fusion and loss of residual joint space. The gap
arthroplasty required for each grade of ankylosis was also analysed.
The complete data in the present study was tabulated in Microsoft
Excel sheet and frequency (n) analysis was done for all variables.
Results: Out of 66 patients (82 ankylotic joints) 37 males and
29 females), age range 2.5-51 years, average age 18.2 years)
27% of the total joints surveyed belonged to grade 1 type of
ankylosis. None of these joints had complete bony fusion
(absence of the radiolucent zone between the cranium and
condyle). A 10% of the joints had moderate ankylosis (grade 2).
None of them revealed complete bony fusion (absence of the
radiolucent zone) or fusion of the sigmoid with the cranial base.
Grade 3 ankylosis was the most widely seen pattern of ankylosis
(63% of the present study subjects) and 92% had a history of
childhood onset. A 90% of the joints in this group had ipsilateral
coronoid hyperplasia. A 48% of the joints with severe ankylosis
(grade 3) showed bony fusion with the cranial base, with loss or
absence of the radiolucent zone {Fusion Line (FL)} between the
cranial base and the condyle.
Conclusion: The extent and severity of TMJ ankylosis needs to
be ascertained prior to planning TM Joint ankylosis surgery. A 3D
CT assessment and subsequent radiologic grading provides a
reliable guide for ankylosis release. |
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| ISSN: | 2249-782X 0973-709X |