Diagnosis and treatment protocol of temporomandibular joint (TMJ) ankylosis: experience from the TMJ Center of Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine

doi:10.3969/j.issn.1674-8115.2022.06.002

Abstract

Abstract:

Temporomandibular joint (TMJ) ankylosis is characterized by limited mouth opening, facial deformity when it happened during growth and obstructive sleep apnea. It is a refractory disease which will seriously affect the mandibular function and facial appearance of the patients. With the development of new technology and accumulating experience, the treatment results have been significantly improved. Based on the literature review, this paper concludes the surgical treatment experience from the TMJ Center of Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, so as to provide reference for clinicians. In the imaging diagnosis of TMJ ankylosis, CT coronal reconstruction is fundamental for the classification of TMJ ankylosis. It can be divided into four types according to the presence and size of residual condyle structure on the medial side of the bony fusion. In addition, jaw deformities, occlusal relationship disorders and respiratory structural disorders associated with TMJ ankylosis can be further classified. Surgical treatment of TMJ ankylosis includes lateral gap arthroplasty (LAP) and joint reconstruction. When there is a condylar structure medially to the bony fusion, which is greater than or equal to 1/2 of the internal and external diameter of the normal condyle, LAP is selected to preserve the condyle and joint disc structure; other types of joint reconstruction include autogenous bone transplantation, artificial joint reconstruction, distraction osteogenesis, etc. Orthognathic surgery can be performed simultaneously or in the second stage to correct combined jaw deformities. Autologous fat transplantation can significantly reduce the recurrence of TMJ ankylosis.

Key words: temporomandibular joint (TMJ), ankylosis, diagnosis, treatment

CLC Number:

R782.2

HE Dongmei, YANG Chi. Diagnosis and treatment protocol of temporomandibular joint (TMJ) ankylosis: experience from the TMJ Center of Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2022, 42(6): 702-708.

Figures/Tables 2

TrendMD

References 59

1	SAWHNEY C P. Bony ankylosis of the temporomandibular joint[J]. Plast Reconstr Surg, 1986, 77(1): 29.
2	NITZAN D W, BAR-ZIV J, SHTEYER A. Surgical management of temporomandibular joint ankylosis type Ⅲ by retaining the displaced condyle and disc[J]. J Oral Maxillofac Surg, 1998, 56(10): 1133-1138;discussion1139.
3	EL-HAKIM I E, METWALLI S A. Imaging of temporomandibular joint ankylosis. A new radiographic classification[J]. Dentomaxillofac Radiol, 2002, 31(1): 19-23.
4	HE D M, YANG C, CHEN M J, et al. Traumatic temporomandibular joint ankylosis: our classification and treatment experience[J]. J Oral Maxillofac Surg, 2011, 69(6): 1600-1607.
5	杨驰. 颞下颌关节强直// 邱蔚六. 邱蔚六口腔颌面外科学[M]. 上海: 上海科学技术出版社, 2008: 869-871.
	YANG C. Temporomandibular joint ankylosis// QIU W L. Oral and maxillofacial surgery[M]. Shanghai: Shanghai Scientific & Technical Publishers, 2008: 869-871.
6	XIA L, AN J G, HE Y, et al. Association between the clinical features of and types of temporomandibular joint ankylosis based on a modified classification system[J]. Sci Rep, 2019, 9(1): 10493.
7	BI R, JIANG N, YIN Q, et al. A new clinical classification and treatment strategies for temporomandibular joint ankylosis[J]. Int J Oral Maxillofac Surg, 2020, 49(11): 1449-1458.
8	BABU L, JAIN M K, RAMESH C, et al. Is aggressive gap arthroplasty essential in the management of temporomandibular joint ankylosis? A prospective clinical study of 15 cases[J]. Br J Oral Maxillofac Surg, 2013, 51(6): 473-478.
9	MEHROTRA D, PRADHAN R, MOHAMMAD S, et al. Random control trial of dermis-fat graft and interposition of temporalis fascia in the management of temporomandibular ankylosis in children[J]. Br J Oral Maxillofac Surg, 2008, 46(7): 521-526.
10	THANGAVELU A, SANTHOSH KUMAR K, VAIDHYANATHAN A, et al. Versatility of full thickness skin-subcutaneous fat grafts as interpositional material in the management of temporomandibular joint ankylosis[J]. Int J Oral Maxillofac Surg, 2011, 40(1): 50-56.
11	LONG X, LI X D, CHENG Y, et al. Preservation of disc for treatment of traumatic temporomandibular joint ankylosis[J]. J Oral Maxillofac Surg, 2005, 63(7): 897-902.
12	HE D M, YANG C, CHEN M J, et al. Surgical treatment of traumatic temporomandibular joint ankylosis with medially displaced residual condyle: surgical methods and long-term results[J]. J Oral Maxillofac Surg, 2011, 69(9): 2412-2418.
13	SINGH V, BHAGOL A, DHINGRA R, et al. Management of temporomandibular joint ankylosis type Ⅲ: lateral arthroplasty as a treatment of choice[J]. Int J Oral Maxillofac Surg, 2014, 43(4): 460-464.
14	YANG X J, LU C, DONG M J, et al. Evaluation of the condyle remodeling after lateral arthroplasty in growing children with temporomandibular joint ankylosis[J]. Sci Rep, 2017, 7(1): 9922.
15	XIA L, HE Y, AN J, et al. Condyle-preserved arthroplasty versus costochondral grafting in paediatric temporomandibular joint ankylosis: a retrospective investigation[J]. Int J Oral Maxillofac Surg, 2019, 48(4): 526-533.
16	GUI H J, WU J Y, SHEN S G F, et al. Navigation-guided lateral gap arthroplasty as the treatment of temporomandibular joint ankylosis[J]. J Oral Maxillofac Surg, 2014, 72(1): 128-138.
17	LU C, HE D M, YANG C, et al. Use of computer-assisted templates for placement of osteotomies in lateral gap arthroplasty[J]. J Oral Maxillofac Surg, 2015, 73(1): 30-38.
18	MOVAHED R, MERCURI L G. Management of temporomandibular joint ankylosis[J]. Oral Maxillofac Surg Clin North Am, 2015, 27(1): 27-35.
19	GILLIES H D. Plastic surgery of the face[J]. Lancet, 1920, 196(5056): 194.
20	HUANG I Y, LAI S T, SHEN Y H, et al. Interpositional arthroplasty using autogenous costal cartilage graft for temporomandibular joint ankylosis in adults[J]. Int J Oral Maxillofac Surg, 2007, 36(10): 909-915.
21	KHADKA A, HU J. Autogenous grafts for condylar reconstruction in treatment of TMJ ankylosis: current concepts and considerations for the future[J]. Int J Oral Maxillofac Surg, 2012, 41(1): 94-102.
22	LU C, HUANG D, HE D M, et al. Digital occlusal splint for condylar reconstruction in children with temporomandibular joint ankylosis[J]. J Oral Maxillofac Surg, 2014, 72(8): 1585-1593.
23	ZHAO J Y, HE D M, YANG C, et al. 3-D computed tomography measurement of mandibular growth after costochondral grafting in growing children with temporomandibular joint ankylosis and jaw deformity[J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2017, 124(4): 333-338.
24	洪民, 李永海, 黄继贤. 喙突移植治疗颞颌关节强直[J]. 解放军医学院学报, 1980, 1(1): 54-58.
	HONG M, LI Y H, HUANG J X. Coronoid process graft in treatment of temporomandibular ankylosisJ]. Acad J Chin PLA Med School, 1980, 1(1): 54-58.
25	ZHU S S, HU J, LI J H, et al. Free grafting of autogenous coronoid process for condylar reconstruction in patients with temporomandibular joint ankylosis[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2008, 106(5): 662-667.
26	ZHANG W N, GU B, HU J, et al. Retrospective comparison of autogenous cosotochondral graft and coronoid process graft in the management of unilateral ankylosis of the temporomandibular joint in adults[J]. Br J Oral Maxillofac Surg, 2014, 52(10): 928-933.
27	CHEN S, HE Y, AN J G, et al. Recurrence-related factors of temporomandibular joint ankylosis: a 10-year experience[J]. J Oral Maxillofac Surg, 2019, 77(12): 2512-2521.
28	HUANG D, LU C, YAO Z D, et al. A comparison of the effect between coronoid process graft and costochondral graft in the reconstruction of temporomandibular joint[J]. J Craniofac Surg, 2016, 27(2): e197-e200.
29	LIU Y M, LI J H, HU J, et al. Autogenous coronoid process pedicled on temporal muscle grafts for reconstruction of the mandible condylar in patients with temporomandibular joint ankylosis[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2010, 109(2): 203-210.
30	SNYDER C C, LEVINE G A, DINGMAN D L. Trial of a sternoclavicular whole joint graft as a substitute for the temporomandibular joint[J]. Plast Reconstr Surg, 1971, 48(5): 447-452.
31	SINGH V, DHINGRA R, BHAGOL A. Prospective analysis of temporomandibular joint reconstruction in ankylosis with sternoclavicular graft and buccal fat pad lining[J]. J Oral Maxillofac Surg, 2012, 70(4): 997-1006.
32	RAO J K D, DAR N, SHARMA A, et al. Evaluation of the sternoclavicular graft for the reconstruction of temporomandibular joint after gap arthroplasty[J]. Ann Maxillofac Surg, 2017, 7(2): 194-201.
33	THIRUNAVUKKARASU R, BALASUBRAMANIAM S, BALASUBRAMANIAN S, et al. Sternoclavicular joint graft in temporomandibular joint reconstruction for ankylosis[J]. Ann Maxillofac Surg, 2018, 8(2): 292-298.
34	SETH S, GUPTA H, KUMAR D, et al. Sternoclavicular graft versus costochondral graft in reconstruction of ankylosed temporomandibular joint[J]. J Maxillofac Oral Surg, 2019, 18(4): 559-566.
35	LIU Y, KHADKA A, LI J, et al. Sliding reconstruction of the condyle using posterior border of mandibular ramus in patients with temporomandibular joint ankylosis[J]. Int J Oral Maxillofac Surg, 2011, 40(11): 1238-1245.
36	MERCURI L G, WOLFORD L M, SANDERS B, et al. Long-term follow-up of the CAD/CAM patient fitted total temporomandibular joint reconstruction system[J]. J Oral Maxillofac Surg, 2002, 60(12): 1440-1448.
37	MERCURI L G, ALI F A, WOOLSON R. Outcomes of total alloplastic replacement with periarticular autogenous fat grafting for management of reankylosis of the temporomandibular joint[J]. J Oral Maxillofac Surg, 2008, 66(9): 1794-1803.
38	WOLFORD L, MOVAHED R, TESCHKE M, et al. Temporomandibular joint ankylosis can be successfully treated with TMJ concepts patient-fitted total joint prosthesis and autogenous fat grafts[J]. J Oral Maxillofac Surg, 2016, 74(6): 1215-1227.
39	ZOU L X, ZHANG L Z, HE D M, et al. Clinical and radiologic follow-up of zimmer biomet stock total temporomandibular joint replacement after surgical modifications[J]. J Oral Maxillofac Surg, 2018, 76(12): 2518-2524.
40	HU Y H, ZHANG L Z, HE D M, et al. Simultaneous treatment of temporomandibular joint ankylosis with severe mandibular deficiency by standard TMJ prosthesis[J]. Sci Rep, 2017, 7: 45271.
41	BAI G, HE D M, YANG C, et al. Application of digital templates to guide total alloplastic joint replacement surgery with biomet standard replacement system[J]. J Oral Maxillofac Surg, 2014, 72(12): 2440-2452.
42	LI H, HE D M, XIE Q Y, et al. Do simultaneous mandibular advancement and temporomandibular joint prosthesis impact the upper airway in TMJ ankylosis patients? [J]. Ann Transl Med, 2021, 9(22): 1638.
43	STUCKI-MCCORMICK S U, FOX R M, MIZRAHI R D. Reconstruction of a neocondyle using transport distraction osteogenesis[J]. Semin Orthod, 1999, 5(1): 59-63.
44	XIAO E, ZHANG Y, AN J, et al. Long-term evaluation of the stability of reconstructed condyles by transport distraction osteogenesis[J]. Int J Oral Maxillofac Surg, 2012, 41(12): 1490-1494.
45	HASSAN S A E H, MOHAMED F I. Distraction osteogenesis in the management of mandibular hypoplasia secondary to temporomandibular joint ankylosis. Long term follow up[J]. J Craniomaxillofac Surg, 2019, 47(10): 1510-1520.
46	YU H B, SHEN G F, ZHANG S L, et al. Gap arthroplasty combined with distraction osteogenesis in the treatment of unilateral ankylosis of the temporomandibular joint and micrognathia[J]. Br J Oral Maxillofac Surg, 2009, 47(3): 200-204.
47	ZHANG C, LI Y F, YE B, et al. Application of bidirectional distraction osteogenesis for the treatment of mandibular micriognathia caused by temporomandibular joint ankylosis[J]. J Craniofac Surg, 2017, 28(6): 1502-1507.
48	SRIVASTAVA D, LUTHRA P, MISHRA S, et al. Technique of dual distraction for correction of unilateral temporomandibular joint ankylosis with facial asymmetry: a case series[J]. J Oral Maxillofac Surg, 2019, 77(12): 2555.e1-2555.e12.
49	ZHANG X H, CHEN M J, WU Y, et al. Management of temporomandibular joint ankylosis associated with mandibular asymmetry in infancy[J]. J Craniofac Surg, 2011, 22(4): 1316-1319.
50	KAUR K, ROYCHOUDHURY A, BHUTIA O, et al. Evaluation of success of transport disc distraction osteogenesis and costochondral graft for ramus condyle unit reconstruction in pediatric temporomandibular joint ankylosis[J]. J Oral Maxillofac Surg, 2020, 78(6): 1018.e1-1018.e16.
51	MITTAL N, GOYAL M, SARDANA D, et al. Outcomes of surgical management of TMJ ankylosis: a systematic review and meta-analysis[J]. J Craniomaxillofac Surg, 2019, 47(7): 1120-1133.
52	AL-MORAISSI E A, EL-SHARKAWY T M, MOUNAIR R M, et al. A systematic review and meta-analysis of the clinical outcomes for various surgical modalities in the management of temporomandibular joint ankylosis[J]. Int J Oral Maxillofac Surg, 2015, 44(4): 470-482.
53	ZHU S S, WANG D Z, YIN Q D, et al. Treatment guidelines for temporomandibular joint ankylosis with secondary dentofacial deformities in adults[J]. J Craniomaxillofac Surg, 2013, 41(7): e117-e127.
54	JIANG Y M, HUANG Y J, YE B, et al. Management of temporomandibular joint ankylosis with dentofacial deformities in children[J]. J Craniofac Surg, 2018, 29(2): e150-e155.
55	GERBINO G, ZAVATTERO E, BERRONE S, et al. One stage treatment of temporomandibular joint complete bony ankylosis using total joint replacement[J]. J Craniomaxillofac Surg, 2016, 44(4): 487-492.
56	KABAN L B, PERROTT D H, FISHER K. A protocol for management of temporomandibular joint ankylosis[J]. J Oral Maxillofac Surg, 1990, 48(11): 1145-1151;discussion1152.
57	KABAN L B, BOUCHARD C, TROULIS M J. A protocol for management of temporomandibular joint ankylosis in children[J]. J Oral Maxillofac Surg, 2009, 67(9): 1966-1978.
58	DURR E D, TURLINGTON E G, FOOTE R L. Radiation treatment of heterotopic bone formation in the temporomandibular joint articulation[J]. Int J Radiat Oncol Biol Phys, 1993, 27(4): 863-869.
59	JENSEN A W, VIOZZI C F, FOOTE R L. Long-term results of radiation prophylaxis for heterotopic ossification in the temporomandibular joint[J]. J Oral Maxillofac Surg, 2010, 68(5): 1100-1105.

[1]	XU Hanwen, CHEN Moxin, LIANG Xiaoyi, SHU Qin, NIE Wanqin, YANG Xuefeng, SHEN Minxuan, LI Xiaojing, CAO Yu, LI Lin. Research progress on intelligent diagnosis of eye diseases based on facial photos [J]. Journal of Shanghai Jiao Tong University (Medical Science), 2025, 45(9): 1249-1255.
[2]	HUANG Xin, LIU Jiahui, YE Jingwen, QIAN Wenli, XU Wanxing, WANG Lin. Development and clinical application of a machine learning-driven model for metabolite-based diagnosis of small cell lung cancer [J]. Journal of Shanghai Jiao Tong University (Medical Science), 2025, 45(8): 1009-1016.
[3]	HUANG Zhouxuan, SHAO Jingbo. Research progress in the treatment of chronic primary immune thrombocytopenia [J]. Journal of Shanghai Jiao Tong University (Medical Science), 2025, 45(4): 508-516.
[4]	ZHOU Zhiyi, ZHAO Hao, MIAO Yifeng, ZHU Chihao, YANG Xi, WANG Siyuan, FENG Junfeng, QIU Yongming. Application of full-neuroendoscopic technique in surgical treatment of posterior cranial fossa lesions [J]. Journal of Shanghai Jiao Tong University (Medical Science), 2025, 45(3): 365-372.
[5]	LIU Chuxuan, ZUO Jiaxin, XIONG Ping. A nomogram based on ultrasound scoring parameters and clinical indicators for differentiating primary Sjὅgren′s syndrome from IgG4-related sialadenitis [J]. Journal of Shanghai Jiao Tong University (Medical Science), 2025, 45(3): 373-380.
[6]	SONG Yijie, CHEN Tianzhen, ZHONG Na, ZHAO Min. Applications and challenges of generative artificial intelligence in psychiatry [J]. Journal of Shanghai Jiao Tong University (Medical Science), 2025, 45(10): 1271-1278.
[7]	LIU Jia, REN Lingjie, SHI Minmin, TANG Xiaomei, MA Fangfang, QIN Jiejie. Identification and evaluation of COL12A1 as a novel serological diagnostic marker in pancreatic ductal adenocarcinoma [J]. Journal of Shanghai Jiao Tong University (Medical Science), 2025, 45(10): 1342-1352.
[8]	DU Fang, ZHOU Lingyun, CHEN Jiao, LIU Danbo, XIANG Hongxian, CHEN Haifei. A case report of relapsed and refractory multiple myeloma with multifocal extramedullary infiltration and pulmonary adenocarcinoma [J]. Journal of Shanghai Jiao Tong University (Medical Science), 2025, 45(1): 122-128.
[9]	CHEN Shentse, CHEN Yiming, WANG Fan, ZHANG Mengke, YANG Weichieh, LÜ Dongbin, HONG Wu. Advances in dietary interventions for the treatment of depression-related symptoms [J]. Journal of Shanghai Jiao Tong University (Medical Science), 2024, 44(8): 1050-1055.
[10]	LÜ Qinyi, GAO Ziqi, FENG Qingchen, MEI Hongxiang, LI Juan. Optimizing arch expansion with clear aligners in the mixed dentition based on finite element analysis [J]. Journal of Shanghai Jiao Tong University (Medical Science), 2024, 44(8): 935-943.
[11]	GUO Yonglin, CHEN Moxin, LIU Zheyuan, LI Yifei, WANG Ziqi, SHU Qin, LI Lin. Progress in diagnosis and treatment of strabismus based on artificial intelligence technology [J]. Journal of Shanghai Jiao Tong University (Medical Science), 2024, 44(3): 393-398.
[12]	LIU Meiling, ZHOU Yabing, WANG Xiaoqiang. Advances in the treatment of intracranial neoplastic lesions in children with neurofibromatosis 1 [J]. Journal of Shanghai Jiao Tong University (Medical Science), 2024, 44(3): 399-406.
[13]	YANG Jingyu, CHEN Liubao, WANG Kangtai, YANG Xingzhi, YU Haitao. Establishment and evaluation of nomogram for differential diagnosis of systemic lupus erythematosus based on laboratory indications [J]. Journal of Shanghai Jiao Tong University (Medical Science), 2024, 44(2): 204-211.
[14]	CHEN Zixuan, LIU Min. Progress in mechanisms and treatment of sunitinib resistance in renal cell carcinoma [J]. Journal of Shanghai Jiao Tong University (Medical Science), 2024, 44(10): 1307-1315.
[15]	ZHU Kaiyuan, SU Yuchen, LIU Zhichao, ZHANG Hong, LI Chunguang, ZHANG Jie, LI Zhigang. Adjuvant strategies for patients with T1b invasion after endoscopic submucosal dissection for esophageal squamous cell carcinoma [J]. Journal of Shanghai Jiao Tong University (Medical Science), 2024, 44(1): 116-123.