Interpositional Arthroplasty in the Treatment of Temporomandibular Joint Ankylosis: A Review of Literature

We have reviewed the clinical and experimental reports regarding interpositional arthroplasty materials in the treatment of temporomandibular joint(TMJ) ankylosis. The aim of this review is to determine what constitutes an ideal interpositional material and whether any of the existing materials reported in the literature provide all requirements of an effective disc substitute following the surgical excision of ankylotic mass. We evaluated these reports in terms of the maximum mouth opening(MMO), aetiology, type of ankylosis, type of graft used, recurrence and other complications. Also we compared the results of the other experimental studies with those of our former experimental study. This was the first report that human amniotic membrane(HAM) had been used as an interposition material. The study has clearly demonstrated that HAM was superior to gap arthroplasty evidenced by vertical, left and right jaw movements in the rabbits clinically. This was supported by histological and radiological investigations, as well. However HAM had the inability to achieve the vertical height of the mandibular ramus, so that a total functional reconstruction was not obtained. In reviewing the literature, it is obvious that there is no ideal interpositional material that provides all the criteria for replacement of a missing articular disc following TMJ discectomy. Although HAM as an interpositional material in tmj ankylosis treatment has not yet been used in human beings, we consider HAM as an interface material with replacing the disc using a cartilage graft might be effective to prevent reankylosis method for treatment of type 1 and 2 of TMJ ankylosis. Corresponding author: Umut Tuncel M.D, Department of Plastic Reconstructive and Aesthetic Surgery, Gaziosmanpasa University, Faculty of Medicine 60100, Tokat, Turkey, Tel: 90 356 212 29 32; Fax: 90 356 215 34 59; E-mail: drumuttuncel@ gmail.com Received October 20, 2011; Accepted November 17, 2011; Published November 19, 2011 Citation: Tuncel U (2011) Interpositional Arthroplasty in the Treatment of Temporomandibular Joint Ankylosis: A Review of Literature. Surgery 1:103. doi:10.4172/2161-1076.1000103 Copyright: © 2011 Tuncel U. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Introduction TMJ ankylosis can be described as a fusion of joint surfaces. This condition can lead to chewing, digestion, speech, aesthetic, oral hygienic problems [1-3]. When 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 intraarticular and false or extraarticular types. Intraarticular ankylosis most commonly occurs after trauma or infection, whereas extraarticular type can occurs by a large variety of disorders including myogenic, neurogenic and inflammatory processes, bone and soft tissue tumors [2-8]. Various procedures have 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 up to 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. Materials and Methods We have reviewed the clinical and experimental reports regarding interposition arthroplasty materials used in the treatment of TMJ ankylosis in terms of preand postoperative measurements of mouth opening, aetiology, type of graft material, type of ankylosis, recurrence and presence of other complications.