ANKYLOSIS SIGNS AND SYMPTOMS

[Anonymous]

UNILATERAL ANKYLOSIS:
-deviation of jaw to the affected site on mouth opening
-prominence of antegonial notch on affected side
-roundness and fullness on affected side and elongation on unaffected side
-restricted mouth opening
-carious teeth
-open bite
-class II malocclusion

BILATERAL ANKYLOSIS:
-mouth opening is highly restricted maximum opening upto 1-1.5mm
-typical bird face appearance
-multiple carious teeth
-severe periodontal problems
-severe classII manifestation
-anterior open bite

        

[drmittal]

Ankylosis of the jaw can be painful and debillitating. Ankylosis, the fusion of the bones making up the joint or calcium deposits around the ligaments of the joint, can be caused by extreme trauma, congenital abnormalcies or rheumatoid arthritis. However, with a few well practiced exercises, pain and possible eventual surgery can be averted.

Is it ankylosis?
Individuals experiencing a tight jaw, regular headaches or disrupted sleep might consider speaking with their dentists to be screened for ankylosis of the jaw. The dentist will be able to diagnose the severity of ankylosis by inspecting how much the mouth opening is inhibited by the bone growth. X-rays or other imaging tests can help determine abnormalities in the bony or soft tissue formations in the joint.

A few exercises for relief
If you experience clicking in your jaw when opening and shutting it, try these few exercises to assuage surgery and further pain. Place your tongue on the roof of your mouth. Opening your mouth wide keeping the tongue in place. Breathe in for two counts, and out for two counts. Release and repeat 10 times.

An isometric exercise will help strengthen the ligaments around your jaw. Make a fist and put it under your chin. Balance the weight of your fist and press as you slowly try to open your jaw. Hold for ten seconds. Release and repeat ten times.

Stretching out the sides of your jaw will help release and relax the muscles around the joint. Make a fist and press against the left side of your jaw, below the hinge. Allow the jaw to press back against the fist. Hold for 10 seconds and release. Repeat 10 times and then apply to the right side of your jaw.

Further relax the muscles by using one finger on each side to press evenly on both sides. Open the jaw very slowly and do not allow the jaw to click. If your jaw clicks, release and start again.

Once your jaw is relaxed, hold your chin between your thumb and pointer finger and loosely, shake your chin from side to side, allowing your jaw to relax and release. Repeat these exercises once a day or as necessary to align your jaw. With these exercises, your jaw will eventually assume the relaxed positions and work in a more efficient fashion.

Still no relief?
If after several weeks of these exercises your jaw is still causing you pain, surgery may be the next step. Surgery will entail removal of the rounded end of the lower jaw bone that forms the temporal mandibular joint. This is then replaced with a prosthetic condyle. Extensive physical therapy usually follows such a surgery.

        

[Anonymous]

Ankylosis

Inability to open the mouth beyond 5mm of interincisal opening due to fusion of the head of the condyle of the mandible with the articulating surface of the glenoid fossa and termed as ankylosis of the Temporomandibular joint. It may be partial or complete or either fibrous or bony.
Classification:

1. Partial or complete ankylosis
2. Fibrous or bony ankylosis
3. False ankylosis or true ankylosis
4. Extra-articular or intra articular ankylosis
5. Unilateral or bilateral ankylosis
Causes of Ankylosis:

1. Causes of mechanical interfere with opening (pseudo-ankylosis):
Trauma: due to fracture of Zygomatic bone or arch
Hyperplasia: developmental over growth of the coronoid process
Neoplasia:

Osteoma
Osteochondroma
Osteosarcoma
Miscellaneous: congenital anomalies

2. Causes of extra caplsular ankylosis (false-ankylosis):
Trauma: wounds or burns which causes periarticular fibrosis
Infection: chronic periarticular suppuration
Neoplasia:

Chondroma
Chondrosarcoma
Fibrosarcoma of the capsule

Particular fibrosis due to:
Irradiation
Oral submucous fibrosis
Progressive systemic sclerosis
3. Causes of intra caplsular ankylosis (true-ankylosis):

Trauma:
Intra-capsular comminuted fracture of condyle
Penetrating wounds
Forcep delivery at birth

Infection:
Otitis media
Osteomyelitis of jaw
Pyogenic arthritis

Systemic juvenile arthritis:
Psoriatic arthropathy
Osteo arthritis
Rheumatoid arthritis

Neoplasia:
Osteoma
Chondroma
Osteochondroma
Miscellaneous:
Synovial chondromatosis
Clinical features:

It occurs in any age but commonly occurs below 10 years.
Both sexes are equally affected.
Inability to open the jaw.
Difficulty in mastication the food.
Compromised oral hygiene and speech.
Disturbance in respiration leading to breathing distress.
Patient has multiple carious teeth in the mouth and seeks consultation for tooth-ache.
A scar on the chin can be seen with history of trauma.
In the unilateral ankylosis, some degree of movement is possible because of the normal joint on the
opposite side. In this case, face is asymmetrical with fullness on the affected side of the mandible

and flattening on the unaffected side.
In bilateral ankylosis, it develops a typical ‘bird face’ appearance with a retruded chin.
In fibrous ankylosis, some degree is also possible.
In bony ankylosis, interincisal opening is invariably less than 5mm.
Radiological examination:
X-rays for TMJ both in open and closed mouth position should be taken.
In fibrous ankylosis, the joint space is visible but no movement of the condyle is seen.
In bony ankylosis, a bony mass is seen in the area of the joint with obliteration of the joint space
along with restricted movement of the condyle.
Cephalometric radiograph is helpful in assessment of the mandibular and maxillary skeletal defects.
Management:
1. Condylectomy
2. Gap arthroplasty
3. Inter positional arthroplasty:
Autogenous:
Temporal muscle
Temporal fascia
Dermis
Cartilaginous grafts-

Costochondral
Sternoclavicular
Auricular cartilage
Alloplastic materials:
Stainless steel
Silastic
Titanium
Tantalum foil/plate

        

[Author]

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