PMC10155879_01
Preoperative mouth opening (A), Computed tomography-scan view showed bilateral ankylosis (B), bony ankylosis right TMJ (C), gap arthroplasty (D), interpositional arthroplasty with Mersilene mesh (E), 3 months postoperative mouth opening (F)
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F1
The maximal opening was two millimeters [Figure 1A], and there was no palpable movement over the bilateral TMJ. Computed tomography scan showed bilateral bony fusion of condyles to glenoid fossae and fusion of the condylar heads to the temporal bones [Figure 1B]. Clinical examination after the right TMJ opening through preauricular incision showed bony fusion of the condylar heads to the temporal bones [Figure 1C]. The patient only wanted the left side of the body operated on. The gap is made by resection of the neck of the condyle by removing the ankylotic mass using a round bur and an osteotome with a gap of about 1 cm wide [Figure 1D]. After removing the resected bone segment and the ankylotic mass, the gap in the neck of the condyle is filled with a folded Mersilene mesh sheet [Figure 1E]. On evaluation at 3 months, although the maximum mouth opening was 30 mm [Figure 1F], the patient still had some difficulty opening her mouth.
Preoperative mouth opening (A), Towne projection of right TMJ (B), Towne projection of right TMJ (C), fibrous ankylosis left TMJ (D), gap arthroplasty (E), interpositional arthroplasty with Mersilene mesh (F), 3 months postoperative mouth opening (G)
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F2
TMJ. The radiograph examination [Figure 2B and C] suggested type I bilateral TMJ (fibrous) ankyloses (Sawhney classification). TMJ [Figure 2D]. The gap was made by resecting the neck of the condyle and removing the fibrous tissue using a round bur and an osteotome with a gap of about 1 cm wide [Figure 2E]. After that the gap in the neck of the condyle was filled with a folded Mersilene mesh sheet [Figure 2F]. On postoperative examination maximum mouth opening recorded was 35 mm [Figure 2G].
Preoperative mouth opening (A), orthopantomograph view of fibrous ankylosis left TMJ (B), Mersilene mesh sheet (C), interpositional arthroplasty with Mersilene mesh (D), 3 months postoperative mouth opening (E)
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F3
TMJ. The patient was diagnosed with type III unilateral TMJ ankylosis (Sawhney classification) based on radiographic examination [Figure 3B]. After taking the resected bone segment and taking the ankylotic mass, the gap in the neck of the condyle was filled with a folded Mersilene mesh sheet [Figure 3C and D]. On postoperative evaluation, the maximum mouth opening recorded was approximately 35 mm [Figure 3F], but the patient still had difficulty opening his mouth.
Preoperative mouth opening (A), Computed tomography-scan view showed bilateral ankylosis (B), TMJ fibrous ankylosis with ankylosing bone formation (C), gap arthroplasty (D), interpositional arthroplasty with Mersilene mesh (E), 3 months post-operative mouth opening (F)
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F4
The maximal mouth opening was only 13 mm [Figure 4A], and there was only very slight movement over the bilateral TMJ. From the radiograph examination [Figure 4B], he was diagnosed with type II bilateral TMJ ankylosis. TMJ region, ankylotic bone mass and fibrous tissue were found in the structural complexity of the right and left TMJ [Figure 4C]. The gap was made by resection of the neck of the condyle by removing the ankylotic mass and fibrous tissue using a round bur and an osteotome with a gap of about 1 cm wide [Figure 4D]. Mersilene mesh sheet [Figure 4E]. Mouth opening exercises and postoperative physiotherapy were carried out and evaluated regularly. The maximum postoperative mouth opening recorded was 40 mm after 3 months [Figure 4F].
Preoperative mouth opening (A and B), Computed tomography-scan view showed unilateral ankylosis left TMJ (C), bony ankylosis left TMJ (D), gap arthroplasty (E), interpositional arthroplasty with Mersilene mesh (F), 3 months postoperative mouth opening (G)
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F5
Maximum interincisal opening was only 0.7 mm [Figure 5A], and no movement was palpable over the bilateral TMJs. TMJ opening through the preauricular incision showed bony fusion of the condylar heads to the temporal bones [Figure 5D]. The gap was made by resection of the neck of the condyle and removing the ankylotic mass using a round bur and an osteotome with a gap of about 1 cm wide [Figure 5E]. After removing the resected bone segment and the ankylotic mass, the gap in the neck of the condyle is filled with a folded Mersilene mesh sheet [Figure 5F]. Although the maximum mouth opening recorded at post-operative evaluation was 27 mm [Figure 5G], the patient still had some difficulty opening his mouth [Table 1].