Management of bilateral temporomandibular joint ankylosis using bilateral custom alloplastic temporomandibular joint prosthesis and genioplasty: A case report

Introduction and importance: Temporomandibular joint (TMJ) ankylosis can be effectively managed through the utilization of autogenous grafts or alloplastic TMJ prostheses. Alloplastic TMJ prostheses are available in two forms: stock or custom. Custom alloplastic TMJ prostheses represent an emerging treatment modality for TMJ ankylosis.Presentation of the case: A 47-year-old female patient presented with a 30-year history of complete inability to open her mouth, chew, speak, and be on a liquid diet. Bilateral TMJ ankylosis and a nine mm right-sided chin deviation were noted. A bilateral osteoarthectomy was performed, followed by reconstruction of the TMJ using a custom alloplastic TMJ prosthesis via an extended preauricular and submandibular approach. The abdominal fat pad was utilized for interposition to prevent recurrence. Genioplasty was carried out through a vestibular approach, shifting the chin nine mm to the left. Postoperatively, the patient achieved a 30 mm mouth opening, and correction of facial asymmetry resulting from chin deviation was observed.Clinical discussion: Treatment options for TMJ ankylosis include autogenous grafts and alloplastic materials. Autografts have limitations such as prolonged surgery, resorption, undergrowth/overgrowth, donor site morbidity, and graft fracture. Stock alloplastic TMJ prostheses may not suit all patients due to anatomical variations. Thus, custom alloplastic TMJ prostheses have emerged as the preferred treatment modality for adult TMJ ankylosis.Conclusion: Custom alloplastic TMJ prostheses are considered an optimal treatment modality for reconstructing the TMJ in adult patients with TMJ ankylosis.