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The Temporomandibular Joints
What is TMJ Ankylosis?
What are the causes of TMJ Ankylosis?
What are the problems associated with TMJ Ankylosis?
What is the treatment for TMJ ankylosis?

Related Topics:
Disorders of Temporomandibular Joint (TMJ)
Orthognathic Surgery

The Temporomandibular Joints are the points of attachment of the lower jaw to the skull. tmj/pic_anatomy Their are two joints, one on each side of the face, just in front of the ears. It is the joint formed by the temporal bone of the skull (Temporo) with the lower jaw or mandible (mandibular). These joints have to move in synchronization each time we chew, talk or swallow. They are among the most complex joints in the human body.
There are two different movements associated with the opening and closing of the mouth. For about the first third of the opening range the movement is hinge-like, and in the last two thirds of the opening range the condylar head slides forward and down. Closing movement occurs in reverse order. The temporomandibular joint also contains a piece of specialized disc, which is primarily made of cartilage, called the Articular Disk. This lies between the condylar head and the temporal bone and prevents these bones from rubbing against each other. The joints are also held together by a series of ligaments and muscles.


What is TMJ Ankylosis?
Ankylosis is the stiffening (immobility) or fixation (fusion) of the joint. Chronic, painless limitation of the movements of the joint occurs.
Intra-articular (true) ankylosis must be distinguished from extra-articular (false) ankylosis. False ankylosis may be caused by enlargement of the coronoid process, depressed fracture of the zygomatic arch, scarring from surgery, irradiation, infection, etc.
True ankylosis of the mandible is one of the most disturbing articular pathosis of TMJ, causing many psychological and physical disturbances. When the pathosis affects both the joints it completely inhibits the movements of the mandible, making chewing, swallowing and speech very difficult. The facial development is impaired resulting in retarded growth of the mandible. Since the condyle of the mandible is the growth center (area of bone growth) for the mandible, any disturbance in this region provokes a change in the development of the mandible. True bilateral congenital ankylosis of the TMJ leads to micrognathia or “bird face”. If ankylosis affects only one side, it produces a lateral deviation of the jaw to the non-affected side, due to the fact that this side continues its growth normally. Therefore the deformity becomes more evident on the normal side, with deficiency on the ankylosed side, causing a facial asymmetry.


What are the causes of TMJ Ankylosis?

Since the condyle of the mandible is an area of bone growth, any inflammatory process in this region, no matter how simple it may be, always provokes a change in the development of the mandible. In most cases of true ankylosis x-rays of the TMJ show loss of normal bony architecture.

What are the problems associated with TMJ Ankylosis? tmj/pic2
Problems associated with ankylosis of TMJ are manifold and can be Functional, Aesthetic (Cosmetic), Psychological (Emotional) or Social.
Ankylosis of Temporomandibular joint may result in:


What are the treatments for TMJ ankylosis?
Over the past few decades numerous treatment methods have been designed and developed by various surgeons for the correction of TMJ ankylosis.

  1. Excision of ankylosis (gap arthroplasty)
  2. Arthroplasty with or without autogenous, alloplastic or allogenic replacement
  3. Condylectomy if the ankylosis is intra-articular or an osteotomy of a part of the ramus if the coronoid process and zygomatic arch are also affected.
  4. Total condylectomy and joint replacement (autogenous, allogenic, alloplastic)
  5. Myotomy
  6. Coronoidectomy or coronoidotomy: This is the excision of the coronoid process of the mandible to release the temporalis muscle.
Therapeutic treatment (biphosphonates, NSAIDS) and physiotherapy to discourage reankylosis of the joint is very important after any surgical corrections. Patient compliance to the postoperative physical therapy is essential to success of any surgical treatment. Jaw-opening exercises must be performed for months to years to maintain the normal mouth opening.

Inter-positioning of the TMJ with temporal fascia or cartilage maybe done to prevent reankylosis of the joint. In cases of bilateral true ankylosis, the treatment is more complex. Facial deformity and asymmetry can be corrected by bone grafts, distraction ontogenesis, orthognathic surgery --- saggital split osteotomy, genioplasty, or Extended-sliding genioplasty (a technique developed and propagated by Dr Varghese Mani).


Related Topics:
Disorders of Temporomandibular Joint (TMJ)
Orthognathic Surgery

* My Homepage * Know your teeth * Know your Gums (Gingiva) * Eruption Dates * Six Golden Rules * Brushing\Flossing Technique * Wisdom tooth * Tooth Decay * Extraction * Dental Implant * Surgical Extraction * Orthognathic Surgery * Asymmetry of the face * Gummy Smile * Prognathism{Long Jaw} * Beggs\Straight wire{Orthodontia} * Bleaching{Tooth Whitening} * Habit Breaking Appliances * Serial ExtractionInterceptive Orthodontics * Discolouration\Veneers * Composite\Amalgam Fillings * Root Canal Treatment{RCT} * Crown{Porcelain\Castmetal} * Flap Surgery/Splinting * Bridges{Porcelain\Castmetal} * TMJ (Joint) Disorders * Bell's Palsy {Facial Paralysis} * Ankylosis{Difficulty in mouth opening} * Cleft Lip and Palate * Trigeminal Neuralgia * In a Lighter vein

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Dr Antony George, Trichur Institute of Head And Neck Surgery (TIHANS),
Shornur Road,Trichur,Kerala-680001,India.
Ph: 0091-0487-335145, 335185
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updated Aug2002.