악관절강직증 치료를 위한 기능ㆍ해부학적 관절성형술

The anatomico-functional gap arthroplasty(AFGA) of temporomandibular joint ankylosis

Temporomandibular joint(TMJ) ankylosis is the very distressing structural condition of the patient irrespective of its nature and magnitude. TMJ ankylosis results from various causes such as trauma, systemic and local inflammatory conditions, neoplasm in the TMJ area, but can be resolved only by direct surgical approach into the TMJ. A number of surgical procedures have been devised to restore normal joint function, but the surgical intervention of TMJ ankylosis is frequently followed by re-ankylosis, occlusal disturbance, retrusion of the mandible, sleep dyspnea, alteration of functional masticatory movement and so on. We present here 11 patients(18 joints) of TMJ ankylosis treated by the anatomico-functional gap arthroplasty technique where by a minimal gap arthroplasty in the region of the obliterated TMJ is completed. The gap arthroplasty was designed as just like the normal anatomical condylar process and glenoid fossa relationship. This minimize deviation of the mandible to the operative side and prevent the anterior open bite and facilitate the normal joint movements. We usually used not only postauricular approach to secure the wide operative field and minimize scar formation and facial nerve damage but also intraoral approach to perform coronoidectomy and complete the antomical gap arthroplasty on the anterior or inferior portion of the joint. Separation of the resected bone surface was achieved using interpositional materials such as dermal graft, temporal facia and ear cartialge graft in order to prevent re-ankylosis while allowing for early postoperative mandibular function. As a result, ankylosed joints were released anatomically and functional movement of the mandible was restored. The reankylosis of the operated joints could be prevented sucessfully by this AFGA technique.