1. D R K E N C A R S O N
TMJ ANKYLOSIS

2. outline
 Definition
 Epidemiology
 Types
 Etiology
 Mechanism/paqthophysiology
 Diagnosis - intra and etra oral signs and symptoms
-radiographic examination
 management

3. the tmj

4. definition
 Limitation of joint movement and functions or
restricted due to pathological fusion of joint parts

5. incidence
 Affects all ages but commonest between ages (0-
10yrs)
 M=F
 More common in Asia

6. Types of ankylosis
 True ankylosis(bony or fibrous)
 False ankylosis
 pseudoankylosis

7. Etiology
Extra-articular (False) Ankylosis
 Muscular Trismus: Due to infection.
Pericoronitis, submasseteric abscess and
pterygomandibular abscess
 Muscular atrophy of fibrosis: due to myositis
ossificans, submucous fibrosis
 Tetany and tetanus: Tetany is due to
hypocalcemia, Tetanus is caused byClostridium tetani.
Early symptoms lock jaw

8.  Neurogenic closure: seen in
nervousness, epilepsy and brain tumors
 Trismus histricus: occurs following acute fright
 Mechanical lock: bony exostosis, osteomas of the
coronoid process and fractures of the coronoid
process

9. Intraarticular (True) Ankylosis
 Birth trauma: occurs in difficult deliveries and is
associated with other bone fractures
 Trauma: 30% of acquired ankylosis
Fracture of the condyle may cause ankylosis due to
intra or extraarticular hemorrhage that may result in
hematoma formation which may be organized or
calcified

10.  Rheumatoid arthritis
 Infection: inflammation of the joint due to direct
extension of infection from the surrounding tissue
e.g ear infection, dental infection or blood borne
infection

12. pathophysiology

13. Signs and Symptoms
 Inability to open the mouth
Slight movement is due to elasticity of the mandible
and the movement in the cranial sutures
 Deviation of the midline
In unilateral ankylosis some degree of movement is
present with deviation to the affected side
 Pain
May be present only in the early stages

14.  Facial deformities
Unilateral cases
 Appear deviated towards the affected side
Bilateral Cases
 Receeding chin due to lack of normal growth of the
mandible. Bird face appearance.
 Malocclusion and bad oral hygiene
 Accentuated antigonial notch due to the action of the muscle
on the ankylosed mandible

17.  Limitation in mouth opening....max 9mm

21. Radiographic Examination
 Panoramic radiograph: gives a general picture for
the TMJ
 TMJ tomography: is useful for examination of the
range of movement of the joint, both hinge and gliding
 CT scan: detects the exact extension of the bony
ankylosis in all direction
 MRI: used to diagnose any abnormalities inthe disc

22. Radiographic features
 Fusion of joint
 Loss of joint space
 Prominent antigonial notch
 Coronoid hyperplasia

24. Non surgical management

26. Surgical management of Ankylosis
Arthrolysis
 Used in fibrous ankylosis
 Consists of breaking down of fibrous tissues by forced opening
of the mandible under GA or surgically
Osteoarthrotomy
 Creation of an artificial joint space (pseudoarthrosis) which is
used in cases of severe arthrosis and fibrous ankylosis

27. Condylectomy
 removal of the condyle
 Used in severe arthrosis and fibrous ankylosis
Arthroplasty
 Aims to prevent the reunion of the bony fragments
 Done after creation of an artificial joint

28. Arthroplaty cont.....
 Replacement of the condyle by bone, transplantation of
digital phalynx or by alloplastic material
 Interpositioning arthroplasty: a foreign material is used
to prevent the recurrence of ankylosis

29. Conti.......
 Resection followed by distractive asteogenesis
 Resection followed by geneoplasty or chin
augmentation(can be used where the ankylosis is
severe and there is economic impediment)

30. Complications of surgery