Abstract
Surgical management of temporomandibular joint (TMJ) ankylosis involves various techniques
from which interpositional arthroplasty (IPA) involves using several materials. The
objectives of this study were to assess and compare post arthroplasty maximum mouth
opening (MMO), symptoms like pain and discomfort in jaw opening and movements, failures
such as reankylosis, neurosensory disturbances, and the effect of confounding variables
such as age, gender, physiotherapy, etc. The search (conducted in September, 2021)
included studies published in English on otherwise healthy individuals (11 months
to 88 years) having undergone arthroplasty with a minimum of six months’ follow up.
We used search engines such as Cochrane database, PubMed, Embase, Scopus, EBSCO host,
Pro quest, J gate, Google Scholar, and manual search to include books and grey literature.
Randomised clinical (RCT) and non-randomised clinical trials, observational studies,
case series and reports meeting the inclusion criteria were selected. Two reviewers
(HD and NP) independently extracted the data. Risk of bias was assessed using the
Cochrane tool, Rangel checklist, and Joanna Briggs Institute. Data were analysed using
RevMan (Version 5.4). Fifty studies with 1524 participants (442 bilateral and 891
unilateral joints) were included; six RCTs, 31 retrospective, 10 prospective, and
three case series and reports. Amongst all interpositional materials, the highest
increase in mouth opening was seen with dermis fat graft with a mean difference (Pooled
MD) being 35.29mm (95% CI [32.36 to 38.22]). Comparison of temporalis myofascial with
gap arthroplasty (GA) showed significant increase in MMO (Pooled MD in mm 1.30 95%
CI [0.14 to 2.45]). Recurrence was significantly reduced when (IPA) was used, compared
with GA (Risk difference 0.08mm 95% CI [−0.15 to −0.02]) and for Temporalis Myofascial
Flap (TMF) when compared with GA (Risk difference −0.07mm 95% CI [−0.15 to 0]). Higher
odds for developing neurosensory disturbances were seen with Al-Kayat Bramley incision
(Pooled OR 0.11 95% CI [0.04 to 0.34]) compared to pre-auricular incision (Pooled
OR 0.03 95% CI [0.01 to 0.09]). IPA was superior to GA with respect to maximum mouth
opening (MMO) (Pooled MD in mm 1.21 95% CI [0.41 to 2.07]). Dermis fat graft offers
the highest MMO. The overall quality of evidence for RCTs is poor while that of observational
studies is moderate as per the relevant assessment of quality of evidence. More research
with appropriate study designs is needed. Similar to the findings from the previous
reviews, outcomes with IPA were superior when compared to GA in terms of mouth opening
and less recurrence.
Keywords
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Article Info
Publication History
Published online: May 30, 2022
Accepted:
May 16,
2022
Received in revised form:
May 1,
2022
Received:
December 23,
2021
Identification
Copyright
© 2022 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
