Use of the suture anchor in interpositional arthroplasty of temporomandibular joint ankylosis.

BACKGROUND

The purpose of this article is to demonstrate the use of a mini suture anchor to attach the temporal myofascial flap to the head of the mandibular condyle in interpositional arthroplasty for the treatment of temporomandibular joint (TMJ) ankylosis.

CASE REPORT

A 29-year-old patient, with unilateral posttraumatic temporomandibular joint osseous ankylosis and pre-operative maximal interincisal distance of 9 mm, was treated by the interpositional gap arthroplasty using the temporal myofascial flap. After rotation, the flap and the TMJ capsule were attached to the lateral pole of the condyle by a non-absorbable mini suture anchor. The surgery was uneventful. On the first post-operative day, the range of motion was considerably improved, with a maximal interincisal distance of 26 mm, a mandibular protrusion of 1 mm and a lateral mandibular excursion of 4 mm to the left and 7 mm to the right. On the 20th post-operative day, the maximal interincisal distance was 30 mm, protrusion 4 mm, the lateral excursion to the right 7 mm and to the left 5 mm. On the third post-operative month, the maximal interincisal distance reached 40 mm.

DISCUSSION

The mini suture anchor demonstrated to be a good tool for the fixation of the temporalis myofascial flap to the condyle, also allowing with the same suture to attach the capsular tissue to the lateral surface of the condyle. The bone-anchored suture permits the restoration of a more physiologic TMJ anatomy. The treatment of TMJ ankylosis should be comprehensive; physiotherapy plays an important role in the rehabilitation period to restore the normal function.