Treatment of temporomandibular joint ankylosis with total prosthetic joint reconstruction: a case series and scoping review of the literature

Abstract

Background: Temporomandibular joint (TMJ) ankylosis affects children and adults throughout the world and causes dramatic loss of jaw function and poses problems for safe airway management. Treatment may represent a challenge due to risks of recurrence of ankylosis or morbidity of surgery. Alloplastic joint reconstruction presents a solution that eliminates donor site morbidity and provides predictable outcomes. Various reports and studies of alloplastic reconstruction have been published, but relatively few have focused specifically on the treatment of patients with ankylosis of the TMJ. The objective of this study is to review literature specifically addressing outcomes for treatment of TMJ ankylosis with total alloplastic reconstruction. Methods: The authors conducted a comprehensive search of several databases from 1990 to January 2022 to identify trends and general outcomes in the treatment of TMJ ankylosis via alloplastic joint reconstruction. There were no language restrictions. Only human studies were included. Evaluations included the type of study, outcomes reported in terms of improved function, and surgical complications. In addition, the authors conducted a retrospective review of Mayo Clinic patients undergoing alloplastic total TMJ joint reconstruction for treatment of TMJ ankylosis to determine outcomes at our institution and ascertain whether or not they are comparable to the world literature. Results: Thirty studies met inclusion criteria, reporting on 398 joint reconstructions. The most common etiologies were trauma and infection. Treatment resulted in improved range of motion, with means ranging from 9.3 to 40.8 mm. Adverse events were relatively uncommon, and only one case of re-ankylosis was reported. The authors’ case series found 10 subjects meeting criteria for inclusion. The most common precipitating factor was prior discectomy. Mean improvement in maximum incisal opening (MIO) was 22 mm, with no cases of re-ankylosis. Conclusions: Alloplastic total TMJ reconstruction with FDA-approved devices is a safe and predictable treatment with a very low risk of re-ankylosis.