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INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

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Unilateral Cleft Lip

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Bilateral Cleft Lip

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Cleft Palate

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Secondary Palatal Repair:Tongue Flaps

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Oral Cancer – Radial Forearm Free Flap

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Oral Cancer – Radial Forearm Free Flap

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Oral Cancer – Anterolateral Thigh Flap

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Fibula Osteocutaneous Free Flap

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Contour Deformity - Face
De-epithelialized Free Groin Flap

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T.M.Joint Ankylosis
Total Rehabilitation

Prof. C. Bhasker Rao
Craniofacial Surgery & Research Centre
S.D.M. College of Dental Sciences & Hospital
Dharwad, Karnataka, India.
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T.M.Joint Ankylosis
Dissertations
1993 - 2002
“Gap arthroplasty in the treatment of T.M. Joint Ankylosis”
- Dr. G. Rajasekhar
“Ankylosis of Craniomandibular Articulation”
“Effects on Skull base and midfacial growth”.

- Dr. Reza Soltanian

“An investigation into probable causes of recurrence after gap
arthroplasty”
- Dr. Sony Jacob
“Non osseous components of T.M. Joint Ankylosis related deformity”
- A Multifactorial analysis.
- Dr. Sunil Dixit
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T.M.Joint Ankylosis
Dissertations
1993 - 2002
“Developmental mechanisms in T.M. Joint Ankylosis”
- Study using C.T. Scan Data and Rabbit Model.
- Dr. Mahindra
“Morphometric basis for correction of secondary mandibular deformities
in unilateral T.M. Joint Ankylosis”.

- Dr. Bhushan Jayade

“Ankylosis of T.M. Joint – “Long term evaluation in post surgical patients”
- Dr. Taranjit
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T.M.Joint Ankylosis
Publications
Salins P.C. et al. Soft and Hard tissue correction
of facial deformity associated with bilateral T.M. Joint
Ankylosis.
Int. J. Oral Maxillofac Surg. 1998, 27: 422 – 424.

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T.M.Joint Ankylosis
Significance ?
• Still common in Asia
• Disabling condition
• Affects growth

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T.M.Joint Ankylosis

Union between the two articulating
surfaces of the joint
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T.M.Joint Ankylosis
Types ?
Fibrous

/

Unilateral

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Bony

Bilateral

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T.M.Joint Ankylosis
Causes ?

• Infection
• Trauma

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T.M.Joint Ankylosis
Infection
• Within the joint
•Vicinity of the joint

• Haematogenic
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T.M.Joint Ankylosis
Trauma
• Birth trauma
• Forceps delivery
• Condylar fractures

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T.M.Joint Ankylosis
Sequelae ?
Direct
Unable to open the mouth
Indirect
Poor oral hygiene
Abnormal feeding habits
Prone for snoring
Effect on growth
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T.M.Joint Ankylosis
Unilateral Ankylosis Effects on Growth
• Fullness of affected side
• Flat normal side
• Deviation of mandible to affected side

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T.M.Joint Ankylosis
Bilateral Ankylosis Effects on Growth

• Retruded chin

• Bird face appearance
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T.M.Joint Ankylosis
Psycho – Sociological problem ?

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T.M.Joint Ankylosis
Patients Experience?

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T.M.Joint Ankylosis
Patients Experience?
Ridiculed by schoolmates
Sympathetic attitude at college
Eating in restaurants an embarrassment
No friends
Loneliness helped in studies
Parents were helpful
Embarrassment at public gatherings
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T.M.Joint Ankylosis
Diagnosis - Clinical

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T.M.Joint Ankylosis
Diagnosis - Imaging

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T.M.Joint Ankylosis
Diagnosis - Imaging

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T.M.Joint Ankylosis
Unsuccessful Management in the Past

• Forcible Distraction
• Orthodontic appliances

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T.M.Joint Ankylosis
Successful Management
• Condylectomy
• Gap arthroplasty
• Inter positional arthroplasty
• Costochondral grafts

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T.M.Joint Ankylosis
Surgical Approaches

End-aural
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Al-Kayat Bramley
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T.M.Joint Ankylosis
Condylectomy
Condyle is removed by sectioning at the neck
• Fibrous ankylosis
• Bony ankylosis where configuration of
condyle is seen

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T.M.Joint Ankylosis
Gap Arthroplasty
Bony Ankylosis
A piece of bone from the ankylosed mass is
removed to create the gap

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T.M.Joint Ankylosis
Gap Arthroplasty

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T.M.Joint Ankylosis
Inter Positional Arthroplasty
Materials interposed to prevent bony contact
• Temporal fascia
• Temporalis muscle
• Costochondral grafts
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T.M.Joint Ankylosis
Inter Positional Arthroplasty
Temporalis muscle & fascia

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T.M.Joint Ankylosis
Costochondral Grafts Indicated
In Children

• Maintains height of ramus
• Further growth of condyle?

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T.M.Joint Ankylosis
Surgeons Perspective
Total Rehabilitation
• Release
• Reconstruction

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T.M.Joint Ankylosis

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T.M.Joint Ankylosis

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T.M.Joint Ankylosis

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T.M.Joint Ankylosis

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T.M.Joint Ankylosis

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T.M.Joint Ankylosis

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T.M.Joint Ankylosis

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T.M.Joint Ankylosis

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T.M.Joint Ankylosis

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T.M.Joint Ankylosis

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T.M.Joint Ankylosis

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T.M.Joint Ankylosis

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T.M.Joint Ankylosis

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T.M.Joint Ankylosis

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T.M.Joint Ankylosis

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T.M.Joint Ankylosis

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T.M.Joint Ankylosis

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Thank you
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