Ankylosis: True vs False

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Questions and Answers

What is the primary reason for immobilizing the mandible after reduction?

To encourage flexibility of the joint

To strengthen the bone structure

To allow for proper alignment of teeth

To facilitate capsular repair and muscle rest (correct)

Which condition is defined as a self-reducing partial dislocation of the TMJ?

Mandibular hypermobility

Temporomandibular joint stiffness

Mandibular subluxation (correct)

Condyle fixation

What is a common treatment recommendation for mandibular subluxation in the absence of pain?

Physical therapy and muscle training

No specific treatment as it is self-reduced (correct)

Mindfulness and relaxation techniques

Immediate surgery

What is the purpose of onlaying non-autogenous material to the articular eminence?

To improve condylar movement Signup and view all the answers

Which scenario can precipitate mandibular subluxation?

During extended periods of mouth opening Signup and view all the answers

Which type of ankylosis is characterized by bony union between the articulating surfaces of the TMJ?

True ankylosis Signup and view all the answers

Which of the following conditions does NOT contribute to false ankylosis?

Bony ankylosis Signup and view all the answers

What type of ankylosis results in fibrous adhesions?

Fibrous ankylosis Signup and view all the answers

Which condition is classified under neurogenic causes that affect jaw mobility?

Brain tumor Signup and view all the answers

What classification describes ankylosis as either unilateral or bilateral?

True ankylosis Signup and view all the answers

Which of the following is NOT considered a cause of false ankylosis?

Bony union of the TMJ Signup and view all the answers

Which condition is characterized by lock-jaw due to persistent tonic spasm of the muscles?

Tetanus Signup and view all the answers

Which form of true ankylosis involves partial or complete bony union?

Bony ankylosis Signup and view all the answers

What is the first stage of surgery for ankylosis typically focused on?

Release of ankylosis with costochondral graft Signup and view all the answers

In what situation is orthognathic surgery typically carried out?

As a secondary procedure after growth completion Signup and view all the answers

What is a common presentation in patients with TMJ dislocation?

Inability to close the mouth Signup and view all the answers

What is the main treatment for reducing mandibular dislocation?

Bimanual mandibular manipulation Signup and view all the answers

In what circumstances should the reduction of mandibular dislocation ideally be performed?

Before the patient experiences muscle spasm Signup and view all the answers

What may be required for the reduction of chronic TMJ dislocation?

General anesthesia Signup and view all the answers

What condition is typically associated with TMJ dislocation?

Neurologic and connective tissue disorders Signup and view all the answers

Which of the following methods can be used to fix a costochondral graft?

Miniplates or lag screws Signup and view all the answers

What condition can result from a difficult delivery, particularly with the use of forceps?

Birth trauma leading to congenital ankylosis Signup and view all the answers

What is a common consequence of osteomyelitis affecting the mandibular condyle?

Limitation of motion and peri-articular swelling Signup and view all the answers

At what age does the involvement of ankylosis usually result in severe facial deformity?

Less than 15 years Signup and view all the answers

What is a characteristic feature of 'bird face' resulting from early-life ankylosis?

Impaction of teeth and malocclusion Signup and view all the answers

Which type of fracture is more likely to cause ankylosis in children rather than adults?

Fracture of the condyle Signup and view all the answers

What is the result of a hematoma within the joint following a skull fracture?

Conversion to fibrous tissue and then bone Signup and view all the answers

What is a typical sign of reduced mouth opening due to ankylosis?

Reduced or no mouth opening Signup and view all the answers

What can lead to suppurative arthritis according to the conditions outlined?

Infection of the ear or mastoiditis Signup and view all the answers

What is the appearance of the chin in unilateral ankylosis?

Chin is deviated to the ankylosed side Signup and view all the answers

What characterizes bird face deformity associated with bilateral ankylosis?

Flat facial features with a micrognathic mandible Signup and view all the answers

Which of the following findings is not typical for a clinical examination in ankylosis diagnosis?

Excessive TMJ movements Signup and view all the answers

If ankylosis is contracted early in life, what is a likely consequence?

Absence of functional stimulation at the growth center Signup and view all the answers

What type of malocclusion is generally associated with the affected side in unilateral ankylosis?

Class II malocclusion Signup and view all the answers

Which of the following is a consequence of untreated ankylosis?

Facial growth and development may be affected Signup and view all the answers

What is the purpose of coronoidectomy in the management of TMJ ankylosis?

To eliminate muscle restriction and improve opening Signup and view all the answers

Which imaging technique is often utilized to visualize bony ankylosis?

3D CT Scan Signup and view all the answers

Study Notes

Ankylosis

Ankylosis is the fusion of joint-ends of bones.
Ankylosis can be false or true.
False ankylosis doesn't involve the joint itself, but is caused by factors like muscle spasm or fibrosis.
True ankylosis involves fibrous adhesions or bony union between articulating surfaces.
True Ankylosis can be fibrous, fibro-osseous, or bony.
True Ankylosis can be unilateral or bilateral and partial or complete.

Causes of False Ankylosis

Muscular trismus: Caused by infection in the muscles of mastication, for examples pericoronitis, or infections near the submasseteric, pterygomandibular, infratemporal or submandibular spaces.
Muscular fibrosis: Caused by long-standing dysfunction like arthritis and myositis.
Myositis ossificans: Progressive ossification following injury and hematoma formation, especially of the masseter muscle.
Tetany: Hypocalcemia leading to muscle spasms and difficulty opening the mouth.
Tetanus: Acute infectious disease caused by Clostridium tetani, leading to lockjaw due to persistent tonic muscle spasm.
Neurogenic causes: Epilepsy, brain tumor, and embolic hemorrhage in the medulla oblongata are also linked to jaw hypomobility.
Trismus hystericus: A disease of psychogenic origin.
Drug-induced spasms: Spasms caused by drug poisoning.
Mechanical blockage: Caused by osteoma or elongation of the coronoid process of the mandible.
Fracture of the zygomatic arch: Fracture leading to inward buckling.
Fracture of the mandible: Reflex muscle spasm.
Scars and burns of the face: Scars and burns can restrict mouth opening.
Cleft palate operations: Can lead to fibrosis of the pterygomandibular raphe, limiting mouth opening.
Submucous fibrosis: Tense fibrous bands from mandible to maxilla limiting movement of the mandible, tongue and soft palate.

Causes of True Ankylosis

Birth trauma: Congenital ankylosis, particularly in cases of difficult delivery or forceps delivery.
Haemarthrosis: Following fracture extending through the mandibular fossa or intracapsular injury. Hematoma within the joint slowly organizes, transforming into fibrous tissue and then bone.
Suppurative arthritis: Infection of the ear or mastoiditis or hematogenous origin.
Rheumatoid arthritis: Atrophy of the muscles can accompany ankylosis.
Osteomyelitis: Affecting the mandibular condyle, leading to limited motion, peri-articular swelling, and suppuration.
Fracture of the condyle: Especially comminuted fractures.

Clinical Features of Ankylosis

Less than 15 years: Severe facial deformity and loss of function.
More than 15 years: Facial deformity is often marginal or absent, but functional loss is severe.
Early ankylosis: A "bird face" can occur, including
- a receding chin
- malocclusion
- impacted teeth
- narrow maxilla
- protruding maxilla
Early ankylosis: Underdevelopment of the mandible with a prominent angle of the jaw and a curve of the inferior border called "ante-gonial notching."
Bilateral Ankylosis:
- Bird face deformity with micrognathic mandible
- Class II malocclusion
- Deep ante-gonial notching
- Severe malocclusion with crowding, protrusive upper anterior teeth, and anterior open bite.
Unilateral Ankylosis:
- Facial asymmetry with affected side appearing normal, opposite side appearing flat.
- Chin deviated to the ankylosed side.
- Ante-gonial notch on the affected side.
- Minimal condylar movements on palpation.
- Class II malocclusion on the affected side and possible crossbite.
Early disease: Destruction of the growth center within the condyle, preventing jaw development and normal tooth eruption.

Diagnosis of Ankylosis

History: Infections or trauma.
Clinical examination:
- Reduced interincisal opening,
- Decreased or absent TMJ movements,
- Scar on the chin due to trauma
Radiological findings:
- CT Scane
- 3D CT scan
- Cone beam 3D CT scan

Untreated Ankylosis

Affected facial growth and development.
Compromised nutrition.
Speech problems.
Sleep apnea (in bilateral ankylosis).
Malocclusion.
Compromised oral hygiene, including impacted teeth and cavities.

Kaban's Protocol for TMJ Ankylosis Management

Early surgical management.
Aggressive total excision of the ankylotic mass.
Coronoidectomy and myotomy on the affected side to eliminate temporalis muscle restriction.
Lining with temporalis muscle/fascia.
If steps 1-3 do not create enough opening, coronoidectomy on the opposite side.
Reconstruction of ramal height with costochondral graft.
Early post-operative mobilization and intensive physiotherapy for at least 6-12 months.
Orthognathic surgery as a secondary procedure after growth completion.

Surgical Procedures

Two stages:
- First stage: Release of ankylosis with costochondral graft for mobility and growth.
- Second stage: Orthognathic surgery for aesthetics.
Single-stage: Release of ankylosis and aesthetic correction in a single procedure (adults or children after growth).
Preauricular incision: Exposes the bony mass.
Osteotomy: Creates a gap between the fossa and the mandible.
Costochondral graft: Fixed with miniplates or lag screws.

Hypermobility

TMJ Dislocation:
- Inability to close the mouth.
- Occurs with neurologic and connective tissue disorders, TMJ dysfunction, and trauma while the mouth is open.
- Often associated with muscle spasm and pain.
- Treatment: Reduction through mandibular manipulation.
  - Acute cases: Reduction without anesthesia.
  - Prolonged or chronic cases: Muscle relaxants and analgesics may be required.
- Prevention: Deepening the glenoid fossa through various procedures.
Mandibular Subluxation:
- Momentary inability to close the mouth.
- Self-reducing partial dislocation.
- Occurs with prolonged mouth opening, trauma, seizures, and Parkinson’s disease.
- Treatment:
  - Often self-reducing.
  - Modifying diet and reducing mouth opening.
  - Procedures like prolotherapy, bite blocks, and surgical intervention.

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Description

This quiz explores the concepts of ankylosis, focusing on its definitions, types, and causes. Participants will learn about the differences between true and false ankylosis, as well as the specific conditions that lead to muscular trismus and fibrosis. Test your knowledge on this important topic in joint health!