This was a case of unilateral TMJ ankylosis in a 24 year old boy from Nigeria. He was not able to open his mouth even for taking food for past 18 years due to an accident. Following the injury, his upper front teeth were lost and he was taking food only through this small gap. 3DCT scan shows TMJ bony ankylosis on the right side and elongated coronoid processes.
Maxillofacial Surgeon Dr. S. M. Balaji planned to open his mouth by following gap arthroplasty with temporalis fascia interpositioning and contralateral coronoidectomy. Under GA, Al-Kayat-Bramley’s incision (Preauricular incision) was made on the right side; a superior limiting cut was made along the demarcation between the rim of the glenoid fossa and the ankylosed head. The ankylotic mass was removed. After ressecting the callous, the gap was further widened by removing adequate bone.
Intraoral coronoidectomy on the contralateral side i.e. the left side was done to facilitate good mouth opening. On the right side, the temporalis muscle was rotated and folded inwards into the joint cavity and taken between the medial surface of the ramus taking good care of the adjacent mandibular nerve, facial and maxillary arteries. Then the muscle end was sutured to the medial side of the mandible to provide a submandibular anchorage. A suction drain is placed for 24-36 hrs and the wound was closed in layers. Results are immediate and mouth opening of inter-incisor width up to 55mm was achieved.
Maxillofacial Surgeon Dr. S. M. Balaji planned to open his mouth by following gap arthroplasty with temporalis fascia interpositioning and contralateral coronoidectomy. Under GA, Al-Kayat-Bramley’s incision (Preauricular incision) was made on the right side; a superior limiting cut was made along the demarcation between the rim of the glenoid fossa and the ankylosed head. The ankylotic mass was removed. After ressecting the callous, the gap was further widened by removing adequate bone.
Intraoral coronoidectomy on the contralateral side i.e. the left side was done to facilitate good mouth opening. On the right side, the temporalis muscle was rotated and folded inwards into the joint cavity and taken between the medial surface of the ramus taking good care of the adjacent mandibular nerve, facial and maxillary arteries. Then the muscle end was sutured to the medial side of the mandible to provide a submandibular anchorage. A suction drain is placed for 24-36 hrs and the wound was closed in layers. Results are immediate and mouth opening of inter-incisor width up to 55mm was achieved.
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