Case: TMJ Ankylosis

Presented by
Mohd Mohsin Jamal
BDS

Submitted to
Dr. Anshul Aggarwal
Oral Medicine and Radiology
Dr. Ziauddin Ahmad Dental College
Case Report

 Presenting the case of Mr. Sarvar, 14 years old male resident of Hapur, who
presented to the OPD-1, Dr. ZADC with a chief complaint of reduced mouth
opening since 9 months.
History Of Present Illness

 As alleged by patient’s attendant, he was apparently well before 9months

ago, he sustained injury on face while his bike skidded on the road. After
accident, patient was taken to a local practitioner in village Bhamedra,
where primary management was done in the form of some injectable &
oral medicine. Pt. noticed reduced mouth opening since the day of
trauma. Then on 13/08/18. patient went to Anand hospital, Meerut, where
patient was recommended to undergo surgery but due to economical
problem, pt.’s attendant could’nt afford. Then on 27/08/18, pt. came to Dr.
ZaDC, OPD-1 for management of aforesaid problem.
….contd.

 Medical history:-
• RTA 9 months before
• Hospitalization 9 months back
 Dental history:- Not significant
 Family history: Not significant
 Personal history: Not significant
 Oral habits : Not present.
Examination

 General physical examination

• Patient is well oriented with time, place and person.
 Vital sign
• Blood pressure:124/82mmhg
• Pulse rate:74/minute
• Respiratory rate: 16/minute
• Temperature : Afebrile
 Anemia: Not Present
 Cynosis: Not Present
 Jaundice: Not Present
Extraoral examination

 Facial symmetry: No gross asymmetry

 Jaw deviation: No midline deviation
 Mouth opening:- 5mm
 Tenderness: Absent.
 Lymph node: Non palpable non inflammatory
 Antegonial notch:- Not prominent
 Palpable bony mass bilaterally i.r.t preauricular region
 Bony prominence present bilaterally i.r.t condylar region
 Lateral movement present only in left side
Intraoral examination

 Lips :Normal
 Cheeks : Normal
 Floor of mouth : Normal
 Vestibule : Normal
 Tongue : Normal
 Palate: Normal
 Orifices of salivary ducts: Normal
 Occlusion:- Intact
 Class I molar relation
Examination of teeth

 Teeth present: 1-7 1-7

1-7 1-7
 Caries : 6
 Missing : none
 Mobile : Not Present
 Wasting diseases : Not Present
 Over retained : Not Present
 Supernumerary : Not Present
 Mal-posed teeth : Not Present
 Root stumps : Not Present
 Hypoplasia: Not Present
 Provisional diagnosis:- Bilateral TMJ ankylosis
 Differential diagnosis:-
• MPDS
• Unilateral TMJ ankylosis
 Final diagnosis:- Bilateral TMJ ankylosis
 Treatment:- Interpositional arthroplasty under general anesthesia
Investigations

 Blood investigations
• RFT
• Blood Sugar
• Serum Electrolyte
• Complete blood count
 Radiographs
• C.T Scan
 Evaluation and Pre-anesthetic checkup
Radigraphic examination

 CT Scan reveals bony fusion of TMJ Complex.

Blood investigations
Treatment

 Prepration
• Patient was laid in supine position and intubated via nasotracheal intubation
and catheterised with foley’s.
• G.A was administered.
• Patient’s face was prepared with betadine and intraorally washed with betadine
solution and draped.
• Site-1&2 were marked with sterile marker for Alkayat & Bramley incision i.r.t left &
right pre-auricular region for left TMJ.
• LA (2% with adr.)was injected in the marking.
….contd.

 Incision
 Alkayat & Bramley incision was given with B.P blade no.12.
 Incision was depened to temporal fascia.
….contd.

 Procedure
 Flap was raised with blunt dissection beneath the fascia, saving the important
vessels.
 The roof of the zygomatic arch was palpated & exposed with the help of blunt
dissection & B.P blade no.12.
 Superficial temporal artery was ligated.
 The bony fusion between temporal bone and condyle was exposed and marked
with the help of 703 bur.
 Bony chunk of 2cm wide was cut with the help of bur & chisel and detached.
 Gauze pack was plased in the cavity
 Same procedure was done for site-2(rt. TMJ)
 Ankylosis was released.
….contd.

 Intra-op mouth opening was measured to be 40mm.

 Temporalis fascia was sutured in both the sites & drains were placed.
 Closure of the site was done with the help of Vicryl 3-0 & Nylon suture.
 Dressing over the incisions were given with drains in place.
 Patient was extubated uneventfully.