Yew Ching Ching, Rahman Shaifulizan Ab, Alam Mohammad Khursheed
School of Dental Sciences, University Science Malaysia, Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia.
Oral and Maxillofacial Surgery Department, School of Dental Sciences, University Science Malaysia, Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia.
BMC Pediatr. 2015 Nov 6;15:169. doi: 10.1186/s12887-015-0495-4.
The Temporomandibular Joint (TMJ) ankylosis in child is rare and yet the causes still remain unclear. This condition that affects the feeding and possible airway obstruction do not only worry the parents, but also possesses as a great challenge to the surgeons. Furthermore, it interferes with the facial skeletal and dento-alveolar development in the on growing child.
In this case report, we presented the management of a 7 year old with left TMJ ankylosis discovered since infant. Clinical and imaging investigations were consistent with left temporomandibular joint ankylosis (Type IV) possible secondary to childhood septic arthritis. Left gap arthroplasty via modified Al Kayat Bramley and retromandibular approach was performed, with interpositional arthroplasty placement of temporalis fascia graft. No complications from the surgery except reduced mouth opening were seen. Possible contributing factors to this less than satisfactory mouth opening are adressed.
We describe here, an unusual childhood temporomandibular joint ankylosis possible due to septic arthritis with delayed surgical intervention. The aetiology, classifications, timing and choice of surgical techniques along with its considerations and complications are discussed. Although there is no consensus on the surgical treatment of TMJ ankylosis, early mobilisation, aggressive physiotherapy and close follow-up are advocated by many authors for successful treatment.
儿童颞下颌关节强直较为罕见，其病因仍不明确。这种情况不仅影响进食，还可能导致气道阻塞，这不仅让家长担忧，也给外科医生带来巨大挑战。此外，它还会干扰儿童面部骨骼和牙-牙槽的发育。
在本病例报告中，我们介绍了一名自婴儿期起就被发现患有左侧颞下颌关节强直的7岁患儿的治疗情况。临床和影像学检查结果与左侧颞下颌关节强直（IV型）相符，可能继发于儿童期化脓性关节炎。通过改良的Al Kayat Bramley手术和下颌后入路进行了左侧间隙关节成形术，并置入颞肌筋膜移植片进行间置关节成形术。除了开口度减小外，未发现手术并发症。文中探讨了导致开口度未达理想效果的可能因素。
我们在此描述了一例因化脓性关节炎导致的不寻常的儿童颞下颌关节强直，手术干预延迟。文中讨论了其病因、分类、手术时机和技术选择及其注意事项和并发症。尽管对于颞下颌关节强直的手术治疗尚无共识，但许多作者主张早期活动、积极的物理治疗和密切随访以实现成功治疗。
