Temporomandibular ankyloses

Temporomandibular ankyloses

Temporomandibular ankyloses

1. Definition :

2. Etiopathogenesis:
3. Etiology  :

– Infectious causes  : 

Work plan

-Inflammatory causes  : 

-Traumatic causes  : 

2) Pathogenesis:

• Total form: 
• Partial forms: 

3. Clinic  :
4. in adults:

One-sided form  : 

Bilateral form: 

2. In children:

          One-sided form:

          Bilateral form  :

4. Imaging:
   • The panoramic view  : 
   • Teleradiography  : 
   • The scanner  : 
   • MRI  : 
5. Diagnosis:

• Differential  :
• Positive  :.

6. Treatment :
7. Surgical TRT  :

2) Functional rehabilitation  : 

Temporomandibular ankyloses

7. Definition :

Temporomandibular ankylosis is a permanent constriction of the jaws by articular fusion (fibrous, bony – unilateral or bilateral).

This permanent constriction is expressed by the reduction or even the absolute and definitive impossibility of all movements of the ATM.

Anatomically, it is characterized by the formation of a bony block that joins the ascending branch to the skull .

8. Etiopathogenesis:
9. Etiology  :
   • Infectious causes  : post-infectious ankyloses are greatly reduced; 

– general infections through the bloodstream

-local infection: nearby infection (otitis, cellulitis, etc.)

• Inflammatory causes  : inflammatory ankylosis can be the origin of rheumatoid polyarthritis,…
• Traumatic causes  : Traumatic ankyloses are due to fractures of the mandibular condyle (intra or extra articular) with internal displacement of the fragment. 
• The interrogation highlights the lack of awareness of the fracture.
• Traumatic ankylosis may be due to severe head trauma, or may be due to a condylar fracture  associated with a fracture of the transverse root of the zygoma or the coronoid process.

Fracture 🡪 Hematoma 🡪 Fibrosis 🡪 Ossification 🡪 Ankylosis

Consequences: The absence of mobility will result in a decrease in adaptive growth and consequently a decrease in the height of the ascending branch. It follows that condylar growth will act very weakly only in a vestibular direction.

3. Pathogenesis:
   • Total form: the entire articular surface is affected, a bony wall is established between the ascending branch and the base of the skull.
   • Partial forms: part or all of a structure can be respected, it can be posterior (tympanocondylar or sphenoid-condylar). It can be anterior and there is fusion of the 2 condyles.
4. Clinic  :
5. in adults:
   • Unilateral form  : Reason for consultation is a limitation of mouth opening which interferes with eating and dental care.

• During questioning, we often find a notion of condylar trauma that went unnoticed or was treated by BIM.
• Simultaneous palpation of the 2 ATMs makes it possible to objectify a painless bone mass on the ankylosed side.
• Limitation of mouth opening and no movement is possible.
• Bilateral form: we find a notion of bicondylar trauma.
• Palpation of the 2 ATMs targets bony masses in the pre-tragal region and the oral opening is limited. When it is <5mm 🡪 total ankylosis (the endo oral examination cannot be performed).

2. In children:
   • One-sided form:

• The earlier the ankylosis, the longer its development and the more severe the deformation.

• There is facial asymmetry with deviation of the chin towards the ankylosed side, the healthy side appears flattened.
• The endooral examination allows the measurement of the mouth opening and identifies altered teeth.
• Bilateral form:

• Bilateral ankylosis gradually leads to hypogenesis of the mandible as a whole.
• The appearance is characteristic, it is said that the child has the profile of a BIRD or SHREW, the chin appears atrophied and withdrawn. This asymmetrical atrophy

resulted in micrognathia.

• Mouth opening is reduced, limited and no movements.
• The occlusion is class II.
• The teeth are particularly affected.

10. Imaging:
    • Panoramic  : can show the ankylosis block.
    • Teleradiography  : in sagittal, frontal and vertical incidence to show deformations.
    • The scanner  : performed in sagittal, coronal and axial sections. These sections specify the extension of the block, its density.

They also specify the state of the glenoid cavity, the sigmoid notch and the longitudinal root of the zygoma.

• MRI  : indicated when the ankylosis is fibrous. It demonstrates the presence of intra or peri- articular fibrous tissue .

11. Diagnosis:

• Differential  :

• With isolated trismus when the etiology is difficult to know, a scan is requested.
• With permanent extra-articular constriction which follows strong irradiation of the bands which follows fibrosis.
  • Positive  : Is done by clinic and x-ray.

12. Treatment :

• In adults: TRT for ankylosis is to free mandibular movements and restore masticatory function while respecting occlusion.
• In children: TRT has a dual purpose; functional and aesthetic and in both cases TRT combines surgery with functional rehabilitation.

1. Surgical TRT  :

• The approach: it is pre-auricular passing through the tragus

• Resection: can range from simple condylectomy to resection of a large block.
• Arthroplasty: TRT of the site (area) of block resection.
• Interposition: -alloplastic materials (resin, metal blade, etc.)

    -autogenous materials (taken from the human body).

    -endo prostheses; small condyles manufactured

    -osteocartilaginous prostheses (responds better)  

2) Functional rehabilitation  : 

Essential for the success of a TRT and it must begin immediately in the days following the intervention.

It must be continued and never < 3 months.

The essential element is mechanotherapy and that uses different methods.

13. Conclusion :

The main cause of permanent jaw constriction is TM ankylosis, which can be prevented in the dental office through early and adequate management of infectious and traumatic lesions.

Good oral hygiene  Regular scaling at the dentist  Dental implant placement Dental x-rays  Teeth whitening  A visit to the dentist  The dentist uses local anesthesia to minimize pain  

Temporomandibular ankyloses