OPTION 2

The treatment of choice for bilateral temporomandibular joint (TMJ) ankylosis in adults is Custom TMJ replacement.
Reasons supporting this approach:
1. Severe Joint Dysfunction and Degeneration
In cases of bilateral ankylosis, the TMJ has typically undergone severe degeneration, often due to trauma, infection, or other pathologies. The ankylotic process causes the joint to become immobile or severely restricted, which results in significant impairment of the mouth opening, chewing, and speaking functions.
🟥Custom TMJ replacement provides a long-term solution by replacing the destroyed joints with prosthetic ones, which can restore both function and mobility of the jaw.
Other procedures, like gap arthroplasty or stock total TMJ replacements, may not adequately address the severe joint destruction seen in adult cases, where anatomical and functional restoration is critical.
2. Personalized Fit and Long-term Functionality
Custom TMJ replacements are designed specifically for the patient, considering their unique anatomical features, which provides several advantages:
🟥Better fit and alignment: A custom implant ensures that the prosthesis matches the patient's individual joint anatomy, leading to improved functionality and a reduced risk of complications (e.g., malocclusion, implant failure, or dysfunction).
Durability: Custom implants tend to last longer and provide better long-term outcomes compared to stock prosthetics, which may not be able to accommodate individual anatomical variations in adult patients.
3. Improved Function and Aesthetic Outcomes
🟥Custom TMJ replacements allow for better restoration of jaw function, including adequate mouth opening and movement. This is especially critical in adults with bilateral ankylosis, as they are more likely to have developed compensatory malocclusion or facial asymmetry due to the limited movement.
🟥Functional restoration: Custom prostheses can be adjusted to help restore proper occlusion and alignment of the bite, which is essential for the patient's ability to chew, speak, and maintain a normal facial appearance.
Aesthetic improvements: Over time, restoring proper joint function and symmetry enhances the patient's appearance and facial harmony.
4. Complexity of Adult TMJ Ankylosis
🟥Bilateral ankylosis in adults is more complex than in children, due to the fully developed and matured structures of the adult face and jaw. The deformities and the extent of joint involvement in adults are usually more severe, making it difficult to achieve satisfactory results with simpler procedures like gap arthroplasty or stock TMJ replacements.
🟥Custom prosthetics allow for greater precision in dealing with such complexities, offering better outcomes for both function and aesthetics.
5. Limitations of Other Options
🟥Gap Arthroplasty: While this procedure (removal of the ankylotic mass and creating a gap between the condyle and glenoid fossa) may provide some relief, it often leads to recurrence of ankylosis, especially in adults where the joint's anatomical and biomechanical conditions have been significantly altered. Gap arthroplasty does not address the underlying joint destruction, and the chances of re-ankylosis or joint instability are higher in adults.
🟥Stock Total TMJ Replacement: These are off-the-shelf implants that may not fit the specific anatomical variations of the adult patient, leading to issues such as poor fit, increased risk of complications, or suboptimal functional outcomes. Additionally, stock prostheses may not restore function or facial appearance as well as custom solutions.
🟥Custom Hemi TMJ Replacement: This procedure involves replacing only one side of the joint (typically unilateral), which may be less effective when both TMJs are affected. Treating bilateral ankylosis with only unilateral replacement could lead to asymmetry and functional problems, and would not address the full extent of the bilateral joint dysfunction.
6. Better Surgical Outcomes and Lower Recurrence Rate
Custom TMJ replacements have been shown to offer better surgical outcomes with a reduced rate of complications like implant failure, recurrent ankylosis, or inadequate jaw mobility. They also facilitate more precise bone recontouring during the procedure, leading to more stable and functional results.