Ankylosis of the temporomandibular joint (TMJ): classification (bone, fibrous), etiology, surgical treatment

Ankylosis temporomandibular joint - violation of his mobility with full or partial restriction.

The development of pathology is affected by fibrous or bone fusion of the joint surfaces. Given the severity of the disease, conservative or surgical treatment may be required.

Causes of ankylosis of the temporomandibular joint

The etiology of the disease can be primary and secondary. In the latter case, the occurrence of ankylosing changes is influenced by other primary conditions developing in this areas: purulent inflammation of the joint, necrotic processes in the bone apparatus, diseases of the inner ear purulent character.

In the history of the disease in children and adolescents, it is most often said about the infectious origin of ankylosis of the TMJ. This is due to the ingress of infectious pathogens into the bloodstream, which became the source of the onset of purulent processes in organs and the articular apparatus.

Infection in the blood in adults occurs against the background of a concomitant infectious process, for example, scarlet fever, diphtheria, gonorrhea. Among the sources of pathology in adults is the development of primary pathology in the adjacent bones or joints (cervical, thoracic).

Less often, ankylosis occurs after a traumatic factor, which entailed fusion of its surfaces. For example, with a direct blow to the temporomandibular joint, bone fracture, bleeding, development of hemarthrosis.

Illness in newborns can occur after severe labor, during which forceps were used. Often, the development of the disease is influenced by other chronic diseases occurring in this department or in nearby areas.

TMJ classification

Ankylosis of the TMJ has several varieties. For example, by etiology, congenital and acquired diseases are distinguished. Ankylosis of a congenital nature is rarely diagnosed. In most cases, it proceeds with other anatomical anomalies in this area.

Given the origin of the disease, ankylosis can be divided into infectious - about 90% of all cases, and post-traumatic - 7% (work by S.A. Yasonov, D.T. Rabiev, A.V. Lopatin "Combination of arthroplasty and distraction lengthening of the mandible in the treatment of children with temporomandibular joint ankylosis«). The first develops against the background of another purulent or infectious process. The second is due to mechanical damage to the joint.

Based on the area of ​​localization of pathological changes, the disease is divided into one-sided and two-sided. Most cases are unilateral. Bilateral ankylosis is less common - when changes equally affect the right and left sides of the face.

Considering the type of changes, bone and fibrous ankylosis of the TMJ are distinguished. With the latter, connective tissue is formed in the gap, which is formed by the articular surfaces. The patient is able to move the jaw, but not fully. This causes pain. An X-ray image shows a sharp narrowing of the joint space.

Bone ankylosis of the TMJ is characterized by a complete limitation of the mobility of the affected area, and there is no pain symptomatology. In this case, there is a complete fusion of the bone surfaces. There is bone tissue in the gap that cannot be seen on an x-ray.

Symptoms and Diagnosis

Clinical manifestations characteristic of ankylosis occurring in the temporomandibular joint are the inability (in whole or in part) to open the oral cavity. In this case, speech and chewing are impaired.

If fibrous ankylosis develops, there is a gradual progression of the pathological process. As the disease progresses, the level of mouth opening decreases. On palpation, there is a decrease in the mobility of the heads. On the X-ray image, the gap between the surfaces of the joint is unevenly narrowed, which is not even traced in some areas.

Bone ankylosis affects one or both joints. A unilateral process is characterized by a displacement of the lower jaw to the side with a lesion. On palpation of the joint, you can see that its heads are motionless. If a bilateral process develops, the base of the body and the branches of the lower jaw are shortened. The chin part sinks, is violated bite, is developing dystopia (incorrect anatomical position of the teeth).

If alarming symptoms are found, especially if it is impossible to fully open the mouth, it is recommended consult a doctor who will prescribe the necessary diagnostic measures and, based on their results, will deliver the final diagnosis.

First of all, a primary examination of the temporomandibular joint is carried out, then additional studies are prescribed:

• x-ray;
• computed and magnetic resonance imaging;
• ultrasound analysis;
• electromyography of the masticatory muscles;
• contrast arthrography;
• orthopantomography.

Differential analysis of ankylosis is carried out with a tumor neoplasm (benign or malignant), the presence of a foreign body (including the post-traumatic period), cicatricial changes in soft tissue, ossifying myositis.

Treatment methods for TMJ ankylosis

What treatment is needed in a particular case is determined taking into account the severity of pathological changes, the characteristics of the primary condition and general health.

Conservative

At the initial stage of the development of pathology, conservative treatment is possible. In this case, joint injections of Hydrocortisone are prescribed. The duration of therapy is 6 injections, administered 1-2 times a week. In the future, absorbable treatment is prescribed using the drugs Lidase, Hyaluronidase.

In the first stages, physiotherapy procedures are prescribed - electrophoresis with drugs to accelerate the regeneration of cartilaginous tissues, ultrasound therapy, phonophoresis.

Operational

Surgical intervention is carried out at an advanced stage, in the presence of a pronounced clinical picture, when the disease prevents a person from leading a normal life, eating, talking.

During the intervention, a skin incision is made on the anterior wall of the ear curl, continuing to the temporomandibular joint. The advantage of such surgery from the cosmetic side: in the postoperative period, there remains a barely noticeable scar with a length of no more than 3-4 mm, located on the outside of the ear.

Surgical intervention is used when it is necessary to reconstruct part of the joint or the entire area. After the elimination of the fusion site, preventive measures are taken to reduce the risk of recurrence of the pathology, for example, suturing of autogenous tissues (ear or costal cartilage) with silicone separation of the articular surfaces membrane.

Prevention and prognosis

Preventive measures are divided into primary and secondary ones. The former are aimed at preventing development, the latter at preventing the recurrence of the disease.

Primary prevention is as follows:

• early selection of an obstetrician-gynecologist, a doctor leading a pregnancy, attending special courses in preparation for childbirth, which will eliminate birth trauma in a child;
• prevention of injury to the temporomandibular joint, responsible treatment arthritis and arthrosis of the TMJ;
• timely therapy of provoking pathologies of infectious and inflammatory etiology.

Secondary prevention is:

• competent treatment, choice of a qualified doctor;
• compliance with the recommendations and appointments of a specialist for the period of therapy;
• full completion of the rehabilitation course;
• regular visits to the doctor to monitor the state of health after undergoing treatment.

If the treatment of the disease is not started in time, severe deformities develop in the facial skeleton, the occurrence of persistent functional disorders is noted.

Based on the overwhelming majority of reviews from those who underwent surgery for surgical treatment of ankylosis of the right temporomandibular joint, it can be concluded that the prognosis is favorable.

After adequate full therapy of TMJ ankylosis, it is possible to normalize the functioning of the lower jaw and restore the aesthetic appearance of the face. However, even after successful treatment, the risk of recurrence of the disease is not excluded.

Therefore, if alarming symptoms occur, you should not self-medicate, but you should immediately consult a doctor.