TMJ Ankylosis Treatment

A sequential protocol for the treatment of TMJ ankylosis is based on aggressive resection of ankylotic mass. While resecting a special approach has to be directed particularly from the medial aspect of the joint which is in close proximity with internal maxillary artery to ensure that bony, fibrous and granulation tissues are completely removed.

Postoperative course: Active mouth opening exercises are started immediately after postoperative pain subsides. Patients are encouraged to start gentle, active and gradually increasing mouth opening exercises using their own fingers as a monitor to start with, in order to gain self-confidence, they are allowed to take a soft diet.

After complete evaluation, a unilateral TMJ arthroplasty with interposing temporalis muscle graft was done under general anesthesia. The patient was intubated using a fiber-optic microscope, which is the recent technique of choice in patients who present with trismus. A Popowich modification of Alkayat and Bramley preauricular incision was employed. Full thickness mucoperiosteal flap was reflected, and the ankylotic mass was exposed After exposing the joint space, an arthrotomy cut was given at the level of the sigmoid notch.

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