Ankylosis is a stiff joint caused by immobility, affecting jaw function. It can lead to inability to open the mouth from partially to fully. Kaban's protocol from 1990 recommends early surgical intervention and aggressive resection for ankylosis, followed by coronoidectomies and temporalis myotomies on both sides if opening is less than 35mm. Reconstruction uses distraction osteogenesis or costochondral grafting, along with early mobilization and physiotherapy. Surgical management of ankylosis addresses complications like hemorrhage, nerve damage, infection and open bite. Recurrence can result from an inadequate gap, graft fracture, inadequate fossa coverage or postoperative physiotherapy.

1. Ankylosis is a Greek terminology meaning ‘stiff joint’.
Here because of immobility of the joint, the jaw function
gets affected. Hypomobility to immobility of the joint
can lead to inability to open the mouth from partial to complete.
Classification of ankylosis
1-False or True
2-Extra-articular or intra articular
3-Fibrous or bony
4-Unilateral or Bilteral
5-Partial or Complete
Kaban’s Protocol 1990
1-Early surgical intervention
2-Aggressive resection
3-Ipsilateral coronoidectomy & temporalis myotomy
4-Contralateral coronoidectomy & temporalis myotomy if incisal opening less
than 35 mm.
5-Lining of glenoid fossa with temporalis fascia
6-Reconstruction of ramus using distraction osteogenesis,
when possible, instead of costochondral grafting
7-Early mobilization & aggressive physiotherapy
8-Long term follow up & cosmetic surgery at later stage
Condylectomy Gap arthroplasty Interpositional arthroplasty
Unilateral Ankylosis
Bilateral Ankylosis
ClinicalFeatures
MANAGEMENT OF TMJ ANKYLOSIS
Surgical Management
Complication of Surgery
Intraoperative
•Hemorrhage
•Damage to external auditory meatus
•Damage to zygomatic & temporal br. Of facial nerve
•Damage to auriculotemporal nerve
•Damage to parotid gland
Postoperative
•Infection
•Open bite
Radiologic features
Recurrence of TMJ ankylosis
1-An inadequate gap created btn fragments
2-Fracture of the costochondral graft
3-Inadequate coverage of glenoid fossa surface
4-Inadequate postoperative physiotherapy
5-Loosening of costochondral graft
Advocated in case of fibrous ankylosis
Pre-auricular incision is made
Horizontal osteotomy cut at the level of
condylar neck with surgical bur
The condylar head is separated from the
superior attachment carefully
Advocated in extensive bony ankylosis
The section consists of two horizontal
osteotomy cuts
Removal of a bony wedge for creation
of a gap between the roof of glenoid
fossa & ramus
creation of gap but in addition a barrier is inserted /Materials
are used to interpose between ramus & base of the skull to
avoid re-ankylosis & to maintain vertical height of ramus.
Fibrous Ankylosis
Bony Ankylosis
Surgical approaches to mandibular condyle
Post Auricular approach Lamport’s Endaural Approach Submandibular Approach Postramal IncisionPreauricular Iccision Alkayat & Bramley’s
Incision