Intra-articular ramus ostectomy combined with costochondral grafting for the treatment of recurrent ankylosis of the mandible

Abstract 

Purpose

This report seeks to demonstrate a technique for treating recurrent ankylosis of the mandible by creating a functional false joint at a level distal to the original joint.

Patients and methods

This is a retrospective study involving patients treated between 1999 and 2003. Under general anaesthesia the ramus was exposed via a submandibular approach and a block of bone was removed from it inferior to the sigmoid notch. Temporary intermaxillary fixation was applied. A costochondral graft was interposed between the resected ends of bone and secured with mini-plates. Postoperatively intermaxillary fixation was maintained for 3 days after which the jaw was actively mobilized.

Results

The technique was used in the treatment of six patients with recurrent ankylosis of the mandible ranging in age from 9 to 38 years. Follow-up was between 1 and 4 years. All the patients had a satisfactory interincisal opening ranging from 25 to 35mm.

Conclusion

The technique does not require the exposure of the ankylosed joint proper but instead creates a false and functional joint at a lower level. It also permits lengthening and advancement of the mandible.

Keywords: Ankylosis, Temporomandibular joint, Costochondral graft, Reconstruction, Pseudo-arthrosis