C. Rozanski1, K. Wood1, P. Sanati1, H. Xu1, P. J. Taub2 1Icahn School of Medicine at Mount Sinai,New York, NY, USA 2Kravis Children’s Hospital at Mount Sinai,Division Of Pediatric Plastic Surgery,New York, NY, USA
Introduction:
Temporomandibular joint (TMJ) ankylosis involves the fusion of the mandibular condyle to the skull base. Surgical interventions include: gap arthroplasty, interpositional arthroplasty, and joint reconstruction. Managing TMJ ankylosis in the pediatric population presents particular challenges due to the need to anticipate unpredictable mandibular growth and high rate of recurrence. While surgical management of TMJ ankylosis is well documented in the literature, there is a lack of consensus regarding which approach is best, especially in pediatrics.
Methods:
A systematic review of PubMed (Jan 1, 1990-Jan 1, 2017) and Scopus (Jan 1, 1990-Jan 1, 2017) was performed by searching an appropriate combination of key words and MeSH terms including “temporomandibular joint ankylosis” and “TMJ ankylosis” with “pediatric” or “pediatrics”. Case reports and case series in the English language including at least one patient under the age of 18 that had a diagnosis of TMJ ankylosis who underwent surgical correction were included for review. Only pediatric cases were included. Main outcomes included preoperative maximum interincisal opening (MIO), postoperative MIO, change in MIO, and complications.
Results:
24 case series and case reports were identified that met inclusion criteria. From these studies, 176 patients and 227 joints were included. There was a significant difference in ΔMIO between intervention groups as determined by one-way ANOVA (p<0.001). Independent sample t-tests comparing MIO variables for each of the intervention groups were performed. MIOpostop (mm) was greater for gap arthroplasty (30.18) compared to reconstruction (27.47) (t=4.9, p=0.043), interpositional arthroplasty (32.87) compared to reconstruction (t=3.25, p=0.002), but not for gap arthroplasty compared to interpositional arthroplasty (t=-1.9, p=0.054). ΔMIO (mm) was not significantly different for gap arthroplasty (28.67) compared to reconstruction (22.24) (t=4.2, p=0.001) or interpositional arthroplasty (28.33) compared to gap arthroplasty (t=0.29, p=0.33). There was no significant difference in incidence of re-ankylosis between treatment modalities.
Conclusion:
Previous studies in adult patients with TMJ ankylosis have suggested interpositional arthroplasty to be superior to gap arthroplasty; however, this distinction has not been explored in pediatrics. The present study found no significant difference in ΔMIO, postoperative MIO, or recurrence of ankylosis between gap arthroplasty and interpositional arthroplasty. Given these nonsignificant differences and the relative technical ease and shorter operation time of gap arthroplasty compared to interpositional arthroplasty, the authors suggest serious consideration of gap arthroplasty for primary ankylosis repair in pediatric patients.