Interposition Gap Arthroplasty of Ankylosed TMJ: A Case Report and Review of the Literature

The temporomandibular joint (TMJ) is the most active, functioning joint of the body. Limitations of the mouth opening and deformity of the lower jaw can be caused by bony or fibrous ankylosis of the TMJ due to various reasons and mostly is due to fusion of the condyle to the base of the skull. Trauma to the TMJ is the most common etiology of ankylosis of TMJ. Clinical examination, radiographic evaluation including Computed Tomography (CT), is essential to confirm the diagnosis. Management of the TMJ ankylosis is mainly by surgical intervention but still composes a considerable challenge because of the high recurrence rate. Interposition arthroplasty in accordance with Kaban protocol was found to be the most successful treatment modality over other techniques due to lesser chance of recurrence while maintaining the ramal height. Though many types of autogenous grafts and alloplastic materials are available for the interposition arthroplasty, the temporalis myofascial flap offers significant advantages like ease of harvesting, minimal donor site morbidity and effective coverage of the arthroplasty site. The present case describes a surgical management of unilateral bony ankylosis of TMJ due to trauma which has been fused with glenoid fossa and root of the zygoma by interposition gap arthroplasty and distraction osteogenesis.