Effectiveness of different surgical modalities in the management of temporomandibular joint ankylosis: a meta-analysis.

BACKGROUND A meta-analysis was conducted to evaluate the effectiveness of three surgical modalities-gap arthroplasty (GA), interpositional gap arthroplasty (IPG) and joint reconstruction (AR)-in treating temporomandibular joint (TMJ) ankylosis. METHODS A systematic review was performed using the PUBMED, EMBASE and OVID search engines in February 2015 to identify cohort studies with no restrictions, with the aim of evaluating the three surgical modalities. The outcome was the change between the pre- and postoperative maximal incisal opening (MIO). Analyses of category, heterogeneity, sensitivity and publication bias were performed. A fixed-effects model was used to compute the pooled weighted mean difference in the MIO among the different groups. RESULT Seventeen studies with 740 participants were included in the final analysis. The IPG therapy showed a significantly greater MIO when compared to GA (WMD=1.16 mm; 95% CI, 0.15-2.16) and AR (WMD=0.99 mm; 95% CI, 0.05-1.92) therapies. The weighted mean difference between the AR and GA modalities was 2.94 mm (95% CI, 0.12-5.75). The pooled odds ratios (ORs) of the recurrence rate for IPG, GA and AR were 0.01 (95% CI, 0.00-0.03), 0.03 (95% CI, 0.00-0.07) and 0.06 (95% CI, 0.04-0.09), respectively. CONCLUSION The analysis showed that IPG was more effective and displayed a lower recurrence rate, followed by AR and GA, in treating TMJ ankylosis. Thus, this analysis provides strong evidence supporting IPG as a first-line therapy for TMJ ankylosis.