Modified Condylar Distraction Osteogenesis via Single Preauricular Incision for Treatment of Temporomandibular Joint Ankylosis

Background: Temporomandibular joint (TMJ) ankylosis with facial asymmetry is still controversial to deal with. This study describes a modified condylar distraction osteogenesis protocol via preauricular approach for the treatment of this condition. Methods: From 2006 to 2013, 18 patients with TMJ ankylosis were enrolled. The Wuhan TMJ Ankylosis treatment protocol includes as follows: (1) preauricular approach is the only surgical access; (2) TMJ arthroplasty is used to recontour the condylar head, and the vertical height of condyle is maintained; (3) distractor placement with distractor port exiting via preauricular incision; (4) distraction after 5 to 7 days of latency period with 0.5 mm twice daily; and (5) distractor removal after 3-month consolidation through preauricular incision. All patients had clinical follow-up and detailed examination. Results: All patients had satisfactory results postoperatively. The mean (range) mouth opening increased from 7.1 (0-18) to 32.1 (28-43) mm during 37 (6-81) months of follow-up period (P < 0.01). Facial asymmetry was corrected in all patients, and all patients had minimal postoperative scar perception of the preauricular incision. Conclusions: The Wuhan TMJ ankylosis protocol provides a safe and effective treatment alternative in managing TMJ ankylosis, especially in young women who are anxious about perceptive extraoral scar.