上海交大：《口腔疾病》（英文版）Treatment of Ankylosis of Temporomandibular Joint

Treatment of Ankylosis of Temporomandibular Joint Definition: intra-articular and extra-articular processes may restrict jaw motion severely Ankylosis of the TMJ is an intra-articular process characterized by fibrous, fibro-oSseous, or osseous obliteration (Hs) of the joint space. Extracapsular causes of restricted jaw motion (pseudoankylosis)include but are not limited to coronoid-zygomatic fusion (RA), coronoid hypertropy, and muscular fibrosis

1 Treatment of Ankylosis of Temporomandibular Joint Definition:intra-articular and extra-articular processes may restrict jaw motion severely. Ankylosis of the TMJ is an intra-articular process characterized by fibrous, fibro-osseous, or osseous obliteration(消失) of the joint space. Extracapsular causes of restricted jaw motion (pseudoankylosis) include but are not limited to coronoid-zygomatic fusion(融合), coronoid hypertropy, and muscular fibrosis

Indications for therapy for ankylosis (may include one or more of the following) Severely restricted jaw motion accompanied by one or more of the following: Inadequate masticatory function ● Abnormal speech .Inability to undergo dental and or medical care Compromised anesthetic management Inhibited facial growth .Imaging evidence of osseous or soft tissue abnormality

2 Indications for therapy for ankylosis (may include one or more of the following) Severely restricted jaw motion accompanied by one or more of the following: •Inadequate masticatory function •Abnormal speech •Inability to undergo dental and /or medical care •Compromised anesthetic management •Inhibited facial growth •Imaging evidence of osseous or soft tissue abnormality

Specific Therapeutic goals for Ankylosis (The goal of therapy is to restore form and/or function. However, risk factors and potential complications may preclude(ji) complete restoration of form and/or function) A. Presence of a general therapeutic goal B. Release of ankylosis C. Access for dental andor medical care D. Improved speech E. Improved masticatory function F. Relief or reduction of pain

3 A. Presence of a general therapeutic goal B. Release of ankylosis C. Access for dental and/or medical care D. Improved speech E. Improved masticatory function F. Relief or reduction of pain Specific Therapeutic Goals for Ankylosis (The goal of therapy is to restore form and/or function. However, risk factors and potential complications may preclude(妨碍) complete restoration of form and/or function)

Specific Factor Affecting Risk for Ankylosis (Severity factors that increase risk and the potential for known complications) A. Presence of a general factor effecting risk B. Type of ankylosis (ie, fibrous or bony) C. Etiology of the ankylosis(eg, traumatic or inflammatory) D. Extent and duration of an kylosis E. Degree of pre-existing muscular atrophy F. Ankylosis in a growing child

4 Specific Factor Affecting Risk for Ankylosis (Severity factors that increase risk and the potential for known complications) A. Presence of a general factor effecting risk B. Type of ankylosis (ie, fibrous or bony) C. Etiology of the ankylosis (eg, traumatic or inflammatory) D. Extent and duration of ankylosis E. Degree of pre-existing muscular atrophy F. Ankylosis in a growing child

Indicated therapeutic standards for ankylosis The pretreatment assessment includes: 1. General history and physical examination 2. Focused history and physical examination of the TMJ region to region to determine the presence of indications for care of ankylosis and to identify factors affecting risks 3. An imaging examination, if indicated, based on the history and physical findings. The examination may include but is not limited to: panoramic radiograph, cephalometric radiograph, conventional tomogram, CT scan, and/or MRI

5 Indicated therapeutic standards for ankylosis 1. General history and physical examination 2. Focused history and physical examination of the TMJ region to region to determine the presence of indications for care of ankylosis and to identify factors affecting risks 3. An imaging examination, if indicated, based on the history and physical findings. The examination may include but is not limited to: panoramic radiograph, cephalometric radiograph, conventional tomogram, CT scan, and/or MRI The pretreatment assessment includes:

Post-treatment management 1. Wound care 2. Pain management 3. Diet and oral hygiene(卫生) management 4. Occlusal management 5. Physical therapy 6. Appropriate diagnostic records to determine progression of the disease 7. Patient reassessment 8. Instruction for post-treatment care and follow-up

6 Post-treatment management 1. Wound care 2. Pain management 3. Diet and oral hygiene(卫生) management 4. Occlusal management 5. Physical therapy 6. Appropriate diagnostic records to determine progression of the disease 7. Patient reassessment 8. Instruction for post-treatment care and follow-up

Management fibrous, fibro-osseous, or osseous ankylosis Arthroscopic surgery(early stage of fibrous ankylosis) Open surgery(most) Arthroplasty Condylectomy: partical or total and +/-replacement (eg, total joint prosthesis, costochondral graft) Gap arthroplasty +/-autogenous or alloplastic or allogeneic interposition(my favor: temporal fascia or auricular cartilage Coronoidectomy or cononoidotomy(often) Orthognathic surgery for residual maxillofacial deformity pseudoan kylosis Osteotomy of zygoma or zygomatic arch Myotomy Coronoidectomy or cononoidotomy Scar revision(eg, intraoral and /or extraoral (adjacent tissue transfer

7 Arthroscopic surgery (early stage of fibrous ankylosis) Open surgery (most) • Arthroplasty • Condylectomy: partical or total and +/- replacement (eg, total joint prosthesis, costochondral graft) • Gap arthroplasty +/- autogenous or alloplastic or allogeneic interposition (my favor: temporal fascia or auricular cartilage) • Coronoidectomy or cononoidotomy (often) • Orthognathic surgery for residual maxillofacial deformity pseudoankylosis • Osteotomy of zygoma or zygomatic arch • Myotomy • Coronoidectomy or cononoidotomy • Scar revision (eg, intraoral and /or extraoral) (adjacent tissue transfer) Management fibrous, fibro-osseous, or osseous ankylosis

Diagnoses Arthroscopic surgery Different Kinds of Adhesions

8 Diagnoses Arthroscopic surgery

reatment ad E IM Preoperation A E postoperation

9 Treatment

CASE REPORT F 33 adhesion between eminence disc PREOPERATION POSTOPERATION

10 Adhesion between eminence & disc CASE REPORT F 33 PREOPERATION POSTOPERATION