Treatment of temporomandibular joint ankylosis with gap arthroplasty and temporal muscle/fascia graft: a case report with five-year follow-up
AbstractPurpose: Temporomandibular joint ankylosis (TMA) is a highly distressing condition in which the Temporomandibular Joint (TMJ) is replaced by scar tissue. The most commonly surgical approach used to restore normal joint functioning is a gap arthroplasty associated with the temporal muscle flap (TMF) as interpositional material. This paper aimed to present a modification of the conventional vascularized temporal muscle flap, and describe an alternative procedure using a muscle/fascia temporal graft as interpositional tissue for the gap arthroplasty. Case description: We report a case of TMA treated using a gap arthroplasty and a variation of the TMF technique as interpositional material, performing a temporal muscle/fascia graft. The technique described is associated with adequate bone removal and excellent intraoperative joint mobilization. Physiotherapy was started 2 days after surgery and maintained for 4 months. During the five years of follow-up, no signs of ankylosis recurrence were observed; maximum mouth opening is currently 35 millimeters. Conclusion: The success in preventing reankylosis after TMJ gap arthroplasty is related primarily to the early postoperative physiotherapy, maintained long-term. A free graft harvested from temporal muscle and used as interpositional material is easy to obtain, reliable, and effective. Another advantage is minimal damage to the temporal muscle and low morbidity.
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