Operative management of temporomandibular joint ankylosis: a systematic review and meta-analysis.
OBJECTIVE
Two common treatments of temporomandibular joint ankylosis are gap arthroplasty and ankylosis resection and reconstruction of the ramus-condyle unit with a costochondral graft. The purpose of the present study was to answer the following clinical question: "Among patients with temporomandibular joint ankylosis, do those patients who undergo gap arthroplasty, compared with those who undergo ankylosis resection and ramus-condyle unit reconstruction with a costochondral graft have better postoperative mandibular range of motion?"


METHODS
A systematic search of the published data was performed to identify eligible studies. The primary predictor variable was treatment type (ie, gap arthroplasty or ankylosis resection and ramus-condyle unit reconstruction). The main outcome was the change in maximal incisal opening postoperatively. A random effects model was used to compute the pooled weighted mean difference between the pre- and postoperative maximal incisal opening in both treatment groups.


RESULTS
Four studies met the inclusion criteria. Those undergoing gap arthroplasty had a significantly greater maximal incisal opening than the group undergoing ankylosis resection and ramus-condyle unit reconstruction. The weighted mean difference between the 2 groups was 2.4 mm (95% confidence interval 0.9 to 4.0; P = .002).


CONCLUSIONS
Subjects with temporomandibular joint ankylosis who underwent gap arthroplasty had significantly better postoperative maximal incisal opening than those undergoing ankylosis resection and ramus-condyle unit reconstruction with a costochondral graft.
Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA 02114, USA.
Alexander
A
Katsnelson
Michael R
MR
Markiewicz
David A
DA
Keith
Thomas B
TB
Dodson
D000844:Ankylosis / Q000150:complications / Q000601:surgery*; D001178:Arthroplasty / Q000379:methods*; D006801:Humans; D008334:Mandible / Q000601:surgery; D017063:Outcome Assessment, Health Care; D016059:Range of Motion, Articular; D013704:Temporomandibular Joint / Q000601:surgery; D013705:Temporomandibular Joint Disorders / Q000150:complications / Q000601:surgery*