Re: Pathogenesis of post-traumatic ankylosis of the temporomandibular joint: a critical review

We read with interest the paper by Arakeri et al. on the pathogenesis of post-traumatic ankylosis of the temporomandibular joint. In this critical review the authors outlined the management and recognised the difficulties in the management of patients with post-traumatic ankylosis. A variety of techniques have been described including gap and interpositional arthroplasty, osteotomy and excision of the ankylotic mass within the TMJ. As far as the reconstruction is concerned again a variety of techniques that utilise bone or alloplastic materials have been described with variable outcomes. In our experience post-traumatic ankylosis is a challenging problem to correct. We recently examined all our patients with ankylosis and have reported our outcomes. Pain was seen to decrease over time and maximal mouth opening improved for females, males and the overall group only over the entirety of the study period. We do advocate a two stage technique with excision of the ankylotic material and with a second stage reconstruction with Custom joints that allows for changes in antero-posterior and vertical dimensions enabling changes in the occlusion to be made (Fig. 1). It is clear from the paper from Arakeri et al. that in the literature there are several studies that advocate a different and maybe equally successful management of such patients. The patient numbers are small for higher level studies and in the era of evidence based medicine it is time to think about a multicenter randomised trial that if well design will give us answer that can only be of benefit to our patients.