Temporomandibular Joint Ankylosis with Maxillary Extension: Proposal for Modification of Sawhney's Classification

Abstract

Temporomandibular joint (TMJ) is a unique joint in which both jaws must open synchronously for function. Any pathology in one or both joints results in functional problems with associated poor quality of life. TMJ ankylosis (TMJA) is a joint pathology as a result of bony and/or fibrous adhesion of the joint apparatus, resulting in partial or total loss of function. This is a retrospective study from two tertiary referral centers in northwest region of Nigeria from 2012 to 2016. Data retrieved include gender, age, etiology of ankylosis, duration of ankylosis, laterality of ankylosis, type of imaging technique, type of airway management, types of incision, surgical procedure, interpositional materials used, and complications. Data were analyzed using SPSS for Window version 20.0 (IBM Corp.). Results were presented as simple frequencies and descriptive statistics. A total of 36 patients with TMJA were seen during the study period; out of which 7 (19.4%) patients had maxillary extension of the ankylotic mass. There was a male: female ratio of 1.3:1. Four (57.1%) patients were within the age group between 5 and 10 years, two (28.6%) within the age group between 11 and 15 years, while only one (14.3%) was within the age group between 31 and 35 years. All the cases (7 [100%]) of maxillary extension were secondary to cancrum oris (noma). Cheek scarring as a result of management of cancrum oris was observed. In addition, intraoral fibrosis eliminating the upper and lower buccal sulci extending to the molar regions was also noted. With the involvement of the maxilla in the ankylotic mass, the authors have proposed modification of Sawhney's classification by the addition of Class V. The authors have suggested a name for the new classification to be “Modified Sawhney's Classification of Temporomandibular Joint Ankylosis”. Aggressive postoperative physiotherapy for a sufficient period of time (minimum of 6 months) is paramount.