Successful correction of TMJ ankylosis with Gap arthroplasty

This was a case of unilateral TMJ ankylosis in a 22 year old girl. She was not able to open her mouth even for taking food for past 20 years. Her upper front teeth were completely decayed and broken. 3DCT scan shows TMJ bony ankylosis on the left side.

Maxillofacial Surgeon Dr. S. M. Balaji planned to open her mouth by following gap arthroplasty with temporalis muscle interpositioning. Under GA, Al-Kayat-Bramley’s incision (Preauricular incision) was made on the left 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.

On the left 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 width up to 44mm was achieved. Patient is put on post surgery physiotherapy to maintain the mouth opening.

Preoperative 3DCT scan showing fused left condyle with that of the cranial base

Inability to open the mouth due to fused condyle on the left side

Preauricular approach to expose the fused joint and cut was made to release the bony fusion

Temporalis muscle interpositioning was done to maintain the movement of the joint

Immediately after relieving the ankylosis mouth opening upto 42mm is achieved