Can treatment of tmj ankylosis cause infective endocarditis
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Bony fusion between the mandibular condyle and skull base involves temporomandibular joint (TMJ) bony ankylosis. This condition might originate from trauma, infection, or systemic disease. TMJ adhesion can develop after synovial damage. Both TMJ ankylosis and adhesion lead to functional impairment and pain. Here, we present a case of a 50-year-old female who had bony ankylosis of the right TMJ and adhesion of the left TMJ. She had otitis media in the right ear. A large mass in the right TMJ was observed on computed tomograph. Magnetic resonance image showed a large fused bone mass with normal bone marrow in the right TMJ and flattening of the condyle with a thin disk in the left TMJ. Gap arthroplasty with temporal fascia was performed on the right TMJ, and discectomy, high condylectomy, and coronoidectomy were performed on the left TMJ. During a 2-year follow-up after surgery, the patient had no recurrence.
Keywords: Temporomandibular Joint, Ankylosis, Arthroplasty, Mouth Rehabilitation
Bony ankylosis of the temporomandibular joint (TMJ) is a fusion between the condyle and the temporal bone, which partially or completely obliterates the articular space and causes joint deformity. The fused bony fragment or a large bone mass may involve the condyle of the mandible, the temporal bone, and the zygomatic process. Thus, bony ankylosis can be easily diagnosed with conventional radiological tools such as panoramic view and computed tomography (CT).1,2,3,4 In 2002, El-Hakim and Metwalli4 reported a new classification of bony ankylosis including surrounding vital structures (Table 1). This classification provides more information to surgeons during the pre-surgical period and during surgery.4 The common causes of ankylosis are trauma (31%-98%), infection (10%-49%), and systemic diseases. TMJ ankylosis negatively affects the patient's quality of life. Because the mouth opening is impaired, mastication and speech are difficult. Generalized caries, poor oral hygiene, facial asymmetry, and obstructive sleep apnea may also occur.5,6,7 The pathogenesis of TMJ adhesion is not yet fully understood.8,9,10 Kaminishi and Davis8 suggested two mechanisms for TMJ adhesion. In the first mechanism, synovitis induces a fibrin layer on the articular surface; this layer becomes the fibrous tissue. In the second mechanism, joint space hematomas become scar-like fibrous tissue during healing. This may eventually develop into fibrous adhesion. Since TMJ adhesion limits anterior and posterior TMJ movements, the mouth opening becomes impaired and is frequently associated with pain.9,10,11 To the best of our knowledge, only a few cases of TMJ ankylosis on one side and TMJ adhesion on the other side have been reported. In this paper, we report a rare case of TMJ ankylosis on one side and severe TMJ adhesion on the opposite side and discuss the radiological diagnosis and treatment of the same.
Keywords: Temporomandibular Joint, Ankylosis, Arthroplasty, Mouth Rehabilitation
Bony ankylosis of the temporomandibular joint (TMJ) is a fusion between the condyle and the temporal bone, which partially or completely obliterates the articular space and causes joint deformity. The fused bony fragment or a large bone mass may involve the condyle of the mandible, the temporal bone, and the zygomatic process. Thus, bony ankylosis can be easily diagnosed with conventional radiological tools such as panoramic view and computed tomography (CT).1,2,3,4 In 2002, El-Hakim and Metwalli4 reported a new classification of bony ankylosis including surrounding vital structures (Table 1). This classification provides more information to surgeons during the pre-surgical period and during surgery.4 The common causes of ankylosis are trauma (31%-98%), infection (10%-49%), and systemic diseases. TMJ ankylosis negatively affects the patient's quality of life. Because the mouth opening is impaired, mastication and speech are difficult. Generalized caries, poor oral hygiene, facial asymmetry, and obstructive sleep apnea may also occur.5,6,7 The pathogenesis of TMJ adhesion is not yet fully understood.8,9,10 Kaminishi and Davis8 suggested two mechanisms for TMJ adhesion. In the first mechanism, synovitis induces a fibrin layer on the articular surface; this layer becomes the fibrous tissue. In the second mechanism, joint space hematomas become scar-like fibrous tissue during healing. This may eventually develop into fibrous adhesion. Since TMJ adhesion limits anterior and posterior TMJ movements, the mouth opening becomes impaired and is frequently associated with pain.9,10,11 To the best of our knowledge, only a few cases of TMJ ankylosis on one side and TMJ adhesion on the other side have been reported. In this paper, we report a rare case of TMJ ankylosis on one side and severe TMJ adhesion on the opposite side and discuss the radiological diagnosis and treatment of the same.
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