TMJ ankylosis is a pathology in which movements in the joint are significantly limited. The disease is usually chronic. The full name of this disease is ankylosis of the temporomandibular joint. Such a pathology significantly complicates a person's life. It becomes difficult for the patient to open his mouth, chew food and talk. In addition, the pathology also affects the appearance, the patient has a pronounced asymmetry of the face. Next, we look at the causes and diagnosis of ankylosis of the TMJ, as well as methods of treatment for this disease.
What is ankylosis
In medicine, ankylosis is a pathology of the articular joint. This is a condition that causes the affected area to become immobile or unable to move normally.
TMJ ankylosis is a fusion of the surfaces of the temporomandibular joint. As a result, the gap between the head of the mandibular bone and the fossa of the temporal bone sharply narrows or completely disappears. Due to inflammatory processes, the tissues of the articular surfaces melt and adhesions form between them.
The disease develops slowly, the pathological process proceeds for many months and even years. Gradually, the cartilaginous surfaces of the joints are destroyed. The intraarticular gap is filled with fibrous or bone tissue.
Causes of disease
The main cause of TMJ ankylosis is infectious inflammatory diseases of nearby organs. Bacteria enter the temporomandibular joint from other foci. Ankylosis can develop as a complication of the following diseases:
- otitis media;
- osteomyelitis of the mandible;
- periostitis;
- mastoiditis;
- arthritis;
- phlegmon in the jaw area;
- newborn sepsis;
- scarlet fever;
- diphtheria;
- gonorrhea.
Any purulent-inflammatory infections of the ENT organs and teeth can have such an unpleasant consequence as ankylosis.
The second cause of fusion of the articular surfaces are jaw injuries: fractures, dislocations and cracks. Such injuries occur when the chin is bruised, for example, when falling from a height or with a direct blow. In infants, trauma to the lower jaw is possible during difficult childbirth, if the obstetrician carelessly placed the forceps on the baby's head. All these injuries are accompanied by hemarthrosis - the outflow of blood into the intraarticular cavity. This can trigger ankylosis.
Classification of pathology
There are several classificationsankylosis of the TMJ.
By origin, this disease is divided into the following groups:
- congenital ankylosis;
- acquired ankylosis.
Congenital pathology is quite rare. Usually it is combined with other anomalies of the facial structure. Most often, joint fusion is acquired and occurs in the process of life.
It is customary to subdivide the disease also depending on its etiology:
- infectious ankylosis;
- traumatic ankylosis.
In the first case, the pathology occurs as a complication of various purulent-inflammatory processes, and in the second - as a consequence of damage to the jaw.
There is also a classification of ankylosis of the TMJ by localization. The following types of joint damage are distinguished:
- one-sided;
- two-sided.
The most common is unilateral ankylosis. Bilateral lesion is observed quite rarely, only in 7% of cases. Pathology occurs on the right or left side with the same frequency.
The disease is also classified according to the type of pathological changes in the joints. In this regard, two types of ankylosis are distinguished:
- fibrous;
- bone.
What is the difference between these pathologies? With fibrous ankylosis of the TMJ, the gap between the articular bones is filled with connective tissue. In this case, a person can make small movements with his jaw. They are usually accompanied by pain. On x-ray, you can see a sharply narrowed gap between the articular bones. This pathology is usuallyobserved in patients of mature age.
With bone ankylosis of the TMJ, a person cannot move his jaw. Pain syndrome is not observed. This form of the disease is accompanied by complete fusion of bone surfaces. The gap between the joints is filled with bone tissue and is invisible on the x-ray. This type of pathology is typical for children and adolescents. It is important to remember that even in an adult, a neglected fibrous form of ankylosis can turn into a bone one. Over time, the connective tissue undergoes ossification.
Some doctors also distinguish partial and complete ankylosis of the TMJ. In the first case, there are still remnants of he althy cartilage tissue on the surface of the bones, in the second case, the joint is completely fused.
Symptomatics
With ankylosis of the TMJ, it becomes difficult for a person to move the lower jaw. The patient experiences serious difficulties in opening his mouth, chewing food, talking. At the beginning of the disease, it becomes difficult for the patient to make only vertical movements with the jaw. As the disease progresses, difficulties arise with horizontal movements. When the disease passes from the fibrous form to the bone, complete immobility of the jaw sets in.
At the fibrous stage, a person is concerned about chronic pain in the jaw. They occur not only when trying to move, but also at rest. The pain syndrome disappears as the connective tissue ossifies. This indicates the progression of the disease. Clicks are heard when the patient tries to open or close the mouth.
The patient's face shape changes. Atunilateral ankylosis, you can notice the shift of the middle facial line to the diseased side. The patient develops an incorrect bite: when the jaws are closed, the rows of teeth intersect.
In some cases, there is noticeable weak development of the lower jaw. The chin looks slanted. A malocclusion is characteristic: the upper rows of teeth partially cover the lower ones. Such manifestations are observed with bilateral ankylosis of the TMJ. Photos of external signs of pathology can be seen below.
Patients have respiratory problems. These manifestations are directly related to the immobility of the jaw. At night, there is a sudden cessation of breathing (apnea), snoring, and often there is a retraction of the root of the tongue.
In addition, the violation of jaw movements adversely affects the condition of the gums and teeth. Patients often develop caries, gingivitis and periodontal disease. This is because the difficulty in opening the mouth makes it difficult for the patient to brush their teeth and undergo dental treatment.
Features of the disease in childhood
With ankylosis of the TMJ in children, severe underdevelopment of the lower jaw is often noted. Such a defect is called "bird's face", or microgenia. It is especially noticeable if you look at the baby in profile. Because of the difficulty in chewing, the child cannot eat normally. This leads to slow weight gain and stunted growth.
In addition to facial deformity, children have abnormal growth of teeth and anomalies in the development of the bite. The child may often suffer from gingivitis and stomatitis due toinability to maintain oral hygiene. Young children have weak teeth.
Sick child has trouble sleeping due to breathing problems. Children wake up due to sudden asphyxia. Often the child cannot sleep on his back, as his tongue and epiglottis sink down. In severe cases, babies may only sleep in a sitting position.
The defeat of the temporal mandibular joint affects the condition of the spine. There comes a curvature of the cervical region with weakening of the muscles. Chewing and facial muscles also lose their tone.
Ankylosis in a child progresses very quickly. This is due to the active growth of bones in childhood. Fibrous tissue in the joint space rapidly ossifies, and the disease passes into a more severe stage.
Complications
Untreated, TMJ ankylosis can lead to serious complications. Respiratory disorders, which are often noted in this disease, are especially dangerous. They can cause death. Retraction of the tongue during sleep often causes vomiting. In this case, the contents of the stomach can enter the respiratory tract, which often causes asphyxia.
For babies under the age of 1 year, sleep apnea attacks are very dangerous. A small child is not always able to wake up with asphyxia. This becomes one of the causes of SIDS (Sudden Infant Death Syndrome), when the baby dies in his sleep from respiratory arrest.
With ankylosis of the TMJ, a person loses the ability to eat normally. For this reason, the patient is rapidly losing weight. Slimming canreach the stage of anorexia. Due to lack of nutrition, the patient's general well-being worsens, weakness and decreased performance.
As already mentioned, patients with ankylosis often lose their teeth. Due to difficulties in opening the mouth, it is difficult for such patients to carry out a full-fledged dental treatment. In such cases, caries often leads to periostitis and phlegmon. In addition, bacteria from the mouth can spread through the bloodstream and cause inflammation in other organs.
Diagnosis
This disease is treated by an orthopedist or surgeon. Examination of the patient begins with examination and palpation of the affected area. Asymmetry of the face and malocclusion are revealed. If the disease arose in early childhood, then there is a violation of the development and growth of teeth.
The patient is offered to open his mouth as much as possible. At the same time, in a patient with ankylosis, the distance between the upper and lower jaws is no more than 1 cm. Normally, a person can open his mouth to a distance equal to the width of three fingers.
During palpation, the doctor examines the mobility of the head of the joint. With ankylosis, lateral sliding movements are not possible.
The most reliable method for diagnosing ankylosis is an x-ray examination. With a fibrous form of pathology, a narrowed joint space is visible in the picture. The edges of the bones in the articulation may be thickened or have a normal shape. With complete fusion of the joint, the head of the bone is destroyed, and the gap is not visible.
If necessary, additional studies are prescribed:cone beam computed tomography of the joint, electromyography and arthrography with a contrast agent. It is important to separate ankylosis from mandibular tumors.
Conservative treatment
Conservative therapy is indicated in the early stages of TMJ ankylosis. Treatment of the disease with the help of medications and physiotherapy is effective in the fibrous form. The patient is prescribed injections of corticosteroid hormones into the joint cavity. Also used drugs that absorb connective tissue:
- "Lidaz";
- "Hyaluronidase";
- "Potassium iodide";
- "Hydrocortisone".
If adhesions in the joint have formed recently, then they dissolve under the influence of such drugs.
Physiotherapeutic procedures are prescribed at the same time:
- ultrasound;
- phonophoresis.
However, such treatment helps only in the very early stages with "young" spikes. In more advanced cases, redressing is done. Under local anesthesia, the jaws are forcibly unclenched. This procedure is carried out with the help of special mouth expanders. After that, in most cases, a person is able to open his mouth to a distance of 3 cm.
After redressing, doctors recommend keeping calm, taking prescribed antibiotics and analgesics. The rehabilitation period after such a procedure lasts about 3-5 days.
After the end of the recovery period, mechanotherapy is indicated. Between the upper and lower jaws are placed specialfixtures. They must be worn from 1 hour to several days. The course of therapy lasts about 3 weeks. Mechanotherapy in many cases helps to bring the opening of the mouth to the physiological norm - 4 cm.
Surgery
Surgical treatment of ankylosis of the temporomandibular joint is indicated for persistent fibrous changes in the joint and in the bone form of the pathology. Carry out the following types of operations:
- Exarticulation. The mandibular head is dissected and then replaced with a graft.
- Osteotomy. The bone union is dissected and a new joint head is created. It is covered with a special cap.
- Dissection of scars. This operation is indicated for pathology of the fibrous type, not amenable to conservative therapy.
After surgical interventions, a splint or special devices are applied to the lower jaw. During the rehabilitation period, the patient needs therapeutic exercises for masticatory muscles, dosed sessions of mechanotherapy, massage and physiotherapy.
Then the patient needs to correct the position of the teeth and bite. For this purpose, orthodontic treatment is used. Braces, mouthguards and special devices are applied to the jaws to straighten the position of the jaws.
After a surgical operation for ankylosis of the temporomandibular joint, some patients' appearance normalizes and facial asymmetry disappears. But if the disease arose in childhood, then microgenia often persists even after surgery.intervention. In this case, plastic surgery of the lower part of the face is necessary.
Forecast
In the early stages, TMJ ankylosis responds well to conservative treatment. In more advanced cases, surgery can correct facial asymmetry, restore normal breathing and speech.
However, there are severe forms of ankylosis that are difficult to treat even with surgery. With them, the disease progresses even after therapy. Therefore, the treatment of ankylosis of the TMJ should be started as early as possible, at the first sign of limited joint mobility.
Prevention
Prevention of ankylosis is the timely treatment of purulent-inflammatory diseases of the upper respiratory tract and jaw injuries. Chin bruises and dislocations should not be ignored. It is also necessary to monitor the condition of the teeth and, if necessary, carry out sanitation of the oral cavity.
If a child has facial asymmetry, poor teething and malocclusion, then you should immediately contact a pediatric orthopedist. This may be a sign of congenital ankylosis. This condition requires immediate treatment, as in children, the fusion of the joint very quickly turns into a severe bone form.
