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Neuroradiology Case of the Week

Case 235

Ashwani K. Sharma, MD and P-L Westesson, MD, PhD, DDS

Clinical Presentation: Patient had limited mouth movement for the past six months with no history of trauma.

Imaging Findings: MR exam shows severe degenerative changes in the left temporomandibular joint with bony ankylosis connecting the condyle to the glenoid fossa. Mild degenerative changes are seen in the right TM joint.

Diagnosis: Bony ankylosis of left TM joint

Discussion: Ankylosis of the temporomandibular joint (TMJ) is a serious and disabling condition. Impairment of speech, difficulty with mastication, rampant caries, poor oral hygiene, disturbances of facial and mandibular growth, and acute compromise of the airway invariably result in physical and psychological disability [1]. This is particularly true of young children who are completely unable to open their mouth [2].
     Ankylosis of TMJ may be classified by a combination of factors: location (intra or extraarticular); type of tissue involved ( bony, fibrous or fibroosseous); and extent of fusion (complete or incomplete).
     Ankylosis is commonly associated with trauma, local or systemic infection or systemic disease [2].
     Three basic techniques have been developed for surgical correction of TMJ ankylosis: gap arthropathy, interpositional arthroplasty and joint reconstruction [3].

References:

1. Chidzonga MM. Temporomandibular joint ankylosis: review of thirty two cases. Br J Oral Maxillofac Surg. 1999 Apr;37(2):123-6. [Medline]
2. Posnick JC, Goldstein JA. Surgical management of temporomandibular joint ankylosis in the pediatric population. Plast Reconstr Surg. 1993 Apr;91(5):791-8. [Medline]
3. Manganello-Souza LC, Mariani PB. Temporomandibular joint ankylosis.Int J Oral Maxillofac Surg. 2003 Feb;32(1):24-9. [Medline]