Technological Advancement in TMJ Ankylosis Surgery: Experience with a Treatment Protocol Including Medical Modeling, Navigation, Ultrasonic Scalpel, Distraction Osteogenesis, and Immediate Range of Motion
Michael Lypka, MD, DMD, Jeffrey Goldstein, MD.
Children's Mercy Hospital, Kansas City, MO, USA.
Purpose: Treatment of temporomandibular joint ankylosis can be a frustrating endeavor with potential intraoperative hazards and high rates of reankylosis. Gap arthroplasty with postoperative physical therapy is the mainstay of ankylosis surgery, with ramus condylar unit (RCU) reconstruction achievable by various means. It is the purpose of this presentation to describe a treatment strategy including preoperative medical modeling, navigation, ultrasonic scalpel, and distraction osteogenesis.
Methods: Four patients with TMJ ankylosis were treated with wide gap arthroplasty, lining of base of skull with temporalis muscle/fascial flap, RCU reconstruction with distraction osteogenesis, and aggressive postoperative physical therapy. Resection was planned virtually and transferred to navigation software to duplicate resection intraoperatively. The planned vector of ramus distraction to create a new condyle was simulated virtually. At surgery, with the aid of navigation, bony resection was performed with an ultrasonic bone cutting device to safely avoid important vasculature medial to the bony resection. With surgical guides to duplicate the preoperative plan, ramus osteotomy was performed and distractor applied. Physical therapy was started on day one and distraction was initiated at 1 mm/day on day 7. Distraction continued until desired RCU length was achieved.
Results: All patients achieved greater than 25 mm of mouth opening with functional RCU reconstruction. One patient had transient facial nerve weakness.
Conclusion: The described protocol has consistently resulted in safe surgery with excellent functional outcomes.
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