Артропластика зазора при анкилозе височно-нижнечелюстного сустава, интерпозиция височной мышцы — ...

This is a case of complete unilateral – left side TMJ ankylosis in a 27-year old female who was not able to open her mouth for the past 22 years. The goal of this surgery is to release the fused left TMJoint by gap arthroplasty, insert the temporalis to prevent future refusion and perform a right side coronoidectomy. This procedure will ensure good mouth opening and also prevent future, potential relapse of the condition. To enable the surgery, a blind, awake intubation through the nose was performed by a very experienced anesthetist. Through a modified Al Kayat- Bramley pre-auricular incision, the head of the condyle was approached on the left TMJ. The left temporal fascia was visualized. By careful dissection, zygoma and fused head of the condyle was reached. The thick callus was identified and carefully trimmed by a round bur with copious running water. With adequate release, the mouth opening was achieved. Intra-orally the right coronoid was approached and a standard cornoidectomy was performed. Mouth opening had to be done with help of gag as the mouth was immobilized and closed for about 22 years. The incision was closed in layers. The temporalis muscle was carefully elevated and rotated to be interplaced between the glenoid fossa and the head of the condyle so that reunion of the bones does not occur. The muscle was ensured that it retained adequate blood supply. The graft was stabilized appropriately. This was done using a customized method which has been published earlier from my center. A drain was placed to prevent accumulation of fluid or hematoma. The incision was carefully closed in layers. The patient was able to open her mouth on the table itself, on recovery from anesthesia #TMJAnkylosis #GapArthroplasty #TMJSurgery #OralSurgery #MaxillofacialSurgery #JawSurgery #TMJTreatment #TMJRecovery #TMJHealth #TMJSpecialist