Question

interpositional arthroplasty with collagen in the treatment of temporomandibular joint ankylosis

Answer 1

TMJ ankylosis can be described as a fusion of joint surfaces. This condition can lead to chewing, digestion, speech, aesthetic, oral hygienicproblems [1-3]. When it occurs during the growing period, it leads to varying degrees of facial deformity and psychological problems [4-7].

TMJ ankylosis is classified into true or Intra-articular and false or Extra-articular types. Intra-articular ankylosis most commonly occurs after trauma or infection, whereas Extra-articular type occurs by a large variety of disorders including myogenic, neurogenic and inflammatory processes, bone and soft tissue tumors [2-8].

Various procedures have been described for the treatment of TMJ ankylosis in the literature. These include gap arthroplasty, interpositional arthroplasty and total joint reconstruction using alloplastic or autogenous materials [5-8]. Since 1893, interpositional arthroplasty has been an advocated treatment method in which an autogenous tissue or alloplastic material is inserted into the gap, separating the bone ends [1]. Although temporalis myofascial flap is referred as a gold standard in the treatment of TMJ ankylosis in the literature, there have been a number of reports that other autogenous grafts including costochondral graft, dermis fat graft, and skin graft or alloplastic materials were also suggested as successful and suitable options. Therefore, temproalis myofasica flap is no longer considered the "gold standard" in the management of ankylosis - alloplastic joint replacement is by most specialist TMJ surgeons. Another option is the use of human amniotic membrane (HAM) as an interpositional material. We have reported HAM as an interposition arthroplasty material with successful results [9]. The main disadvantage of this method was the inability to achieve the vertical height of the mandibular ramus, and a total functional reconstruction was not obtained. Therefore no single method has produced uniformly successful results until now. Reankylosis and limited range of motion are the most frequently reported complications [3].

The goal of this paper was to review interpositional arthroplasty materials in terms of the maximal mouth opening results obtained and to provide the reader with an evidence-based review of the literature in order to determine the most efficient way to manage TMJ ankylosis and reankylosis.




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