Ankylosis and Facial Asymmetry Disorders

Man holding jaw in pain due to jaw disorder

High Condylectomy & Temporal Fascia Graft

In cases where the jaw opening ability is severely compromised due to ankylosis, it is necessary to perform surgical treatment of the TM joint. This involves a high condylectomy (removing approximately 4 mm on top of condyle) and grafting tissue between the bone components. In most cases, the oral surgeon will place an interposition autologous graft between the fossa and remaining portion of the condyle to prevent adhesion or re-ankylosis. One successful graft is a piece of temporal muscle fascia, although other autologous grafts have been used.

Diagnoses linked with this treatment include:

  1. Ankylosis (fibrosis or bony)
  2. TMJ condyle osteochondroma
  3. Severe facial asymmetry

Related Reading: 4 Mandibular Mobility Disorders

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Total Condylectomy & Joint Replacement

In cases where it is necessary to remove the entire condyle down to the neck, one surgical option is a total joint replacement implant. These mostly titanium implants are often custom made to fit the ramus and fossa of the patients unique jaw shape and form.

Diagnoses linked with this treatment include:

  1. Condyle tumor that needs resection
  2. Condyle ankylosis
  3. Fractured condyle that has caused a significant occlusal change due to length change in the mandible on the fractured side

Related Reading: Internal Derangements of the Temporomandibular Joint

Genioplasty Surgery

In some cases of jaw asymmetry due to hyperplasia or hypertrophy of the lower jaw or condyle, the chin is tipped or off center. The patients cosmetic concerns can be addressed with a much simpler procedure involving only a sliding genioplasty or a chin implant.

Diagnoses linked with this treatment include:

  1. Facial asymmetry where the growth has stopped and chin is off-center

Orthognathic Surgery

In cases of severe malocclusion, this problem is almost always a surgical or orthodontics approach involving either sliding mandibular osteotomy or maxillary surgery. It is often desirable to correct a major class III malocclusion with a maxillary surgical advancement rather than a mandibular surgical set-back procedure.

Moving the lower jaw posteriorly can induce a compromised airway as the tongue always moves back when the jaw is set back. This can induce an obstructive sleep apnea. In cases of facial asymmetry due to hyperplasia of the mandible and/or maxilla, the most common solution is surgical treatment of the mandible.

The bilateral sagittal split mandibular osteotomy procedure can usually correct the asymmetry without compromising the airway. Usually, in these cases, a pre- and post-surgical orthodontics is also needed. Unfortunately, this treatment does not repair or correct an internal derangement of the TMJ. It is primarily a cosmetic procedure.

Diagnoses linked with this treatment include:

  1. Facial asymmetry
  2. Maxillomandibular insufficiency causing a skeletal malocclusion.

Costochondral Rib Graft

If a condyle fails to develop or undergoes resorption after a fracture or due to an osteolytic process, one treatment approach is to perform a costochondral rib graft. This method has some advantages and disadvantages.

One advantage is that if the patients are young and still growing, it is possible to graft their own rib with a growth plate. Assuming the rib graft is successful the growth plate will grow and reduce the severity of the asymmetry.

The disadvantage is that the growth of the grafted side is usually not coordinated with the growth of the intact condyle. An asymmetry of the jaw is still likely to happen. The resulting asymmetry is usually less than what would have happened if the missing or malformed condyle were left untreated.

Correcting the asynchronous growth problem will typically require a second orthognathic treatment after growth has ceased. Costochondral rib grafts are not done in adults or teenagers that have stopped growing. In these cases, a total joint replacement is preferred.

Diagnoses linked with this treatment includes:

  1. TMJ condyle hypoplasia
  2. Ankylosis (fibrosis or bony)

Related Reading: How to Diagnose 7 Maxillary Growth Disorders

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