Research Article
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Evaluation of The Gap Volume Following Temporomandibular Joint Ankylosis Surgery: A Preliminary Study

Year 2025, Volume: 15 Issue: 3, 538 - 544, 30.09.2025
https://doi.org/10.33808/clinexphealthsci.1553841

Abstract

Objective: This retrospective study quantitatively evaluated linear and volumetric dimensions of the joint space created following gap arthroplasty (GA) and interpositional arthroplasty (IA) in temporomandibular joint ankylosis (TMJA) management, analyzing 10 patients (7 female, 3 male).
Methods: Demographic, etiological, and surgical data were extracted from institutional archives. Pre- and postoperative cone beam computed tomography (CBCT) scans enabled joint space assessment, with linear measurements at anterior (AJS), superior (SJS), and posterior (PJS) joint spaces in coronal views. Three-dimensional volumetric analysis was performed using Mimics Innovation Suite Software.
Results: GA demonstrated a mean interosseous distance of 5.92 mm (range: 3.56-9.78 mm) with corresponding space volumes ranging from 560.46 mm³ to 2194.66 mm³. IA showed mean interosseous distances at 6.85 mm (range: 2.8-11.83 mm), with volumetric measurements between 910.73 mm³ and 2738.08 mm³. All patients achieved clinically significant improvements in maximum interincisal opening, with a mean increase of 28.09 mm. Notably, no cases of reankylosis were observed throughout the mean follow-up period of 16.2 months.
Conclusions: Both GA and IA effectively restored TMJ function, with early physiotherapy initiation being a critical success factor. While cost-effective, procedure selection should be individualized based on age, ankylosis type, and anatomical considerations. Although limited by sample size and follow-up duration, these findings validate both techniques, warranting further large-scale studies to establish definitive guidelines.

Ethical Statement

The protocol of this retrospective study was approved by the Institutional Review Board of the Hacettepe University, Ankara, Turkey (IRB No. GO 19/369), and informed consent was obtained from the patients.

Supporting Institution

The authors received no financial support for the research.

Thanks

We would like to thank Hacettepe University for providing access to academic databases.

References

  • Chouinard A-F, Kaban LB, Peacock ZS. Acquired abnormalities of the temporomandibular joint. Oral Maxillofac Surg Clin North Am. 2018;30(1):83-96. http://dx.doi.org/10.1016/j.coms.2017.08.005.
  • Al-Moraissi E, El-Sharkawy T, Mounair R, El-Ghareeb T. A systematic review and meta-analysis of the clinical outcomes for various surgical modalities in the management of temporomandibular joint ankylosis. Int J Oral Maxillofac Surg. 2015;44(4):470-482. https://doi.org/10.1016/j.ijom.2014.10.017.
  • Rozanski C, Wood K, Sanati-Mehrizy P, Xu H, Taub PJ. Ankylosis of the temporomandibular joint in pediatric patients. J Craniofac Surg. 2019;30(4):1033-1038. https://doi.org/10.1097/SCS.0000000000005547.
  • Rajurkar SG, Makwana R, Ranadive P, Deshpande MD, Nikunj A, Jadhav D. Use of temporalis fascia flap in the treatment of temporomandibular joint ankylosis: a clinical audit of 5 years. Contemp Clin Dent. 2017;8(3):347-351. https://doi.org/10.4103/ccd.ccd_1138_16.
  • Liu X, Shen P, Zhang S, Yang C, Wang Y. Effectiveness of different surgical modalities in the management of temporomandibular joint ankylosis: a meta-analysis. Int J Clin Exp Med. 2015;8(11):19831. .
  • Mittal N, Goyal M, Sardana D, Dua J. Outcomes of surgical management of TMJ ankylosis: A systematic review and meta-analysis. J Craniomaxillofac Surg. 2019;47(7):1120-1133. https://doi.org/10.1016/j.jcms.2019.03.029.
  • De Meurechy NK, Loos P-J, Mommaerts MY. Postoperative physiotherapy after open temporomandibular joint surgery: A 3-step program. J Oral Maxillofac Surg. 2019;77(5):932-950. https://doi.org/10.1016/j.joms.2018.12.027.
  • Çakarer S, Isler SC, Yalcin BK, Diracoglu D, Uzun A, Sitilci T. Autogenous dermis-fat graft in temporomandibular joint ankylosis surgery. Ann Maxillofac Surg. 2018;8(1):162-165. https://doi.org/10.4103/ams.ams_179_17.
  • Dhabale GS, Bhowate RR, Bhowate R. Cone-beam computed tomography for temporomandibular joint imaging. Cureus. 2022;14(11). https://doi.org/10.7759/cureus.31515.
  • Cho J-W, Park J-H, Kim J-W, Kim S-J. The sequential management of recurrent temporomandibular joint ankylosis in a growing child: a case report. Maxillofac Plast Reconstr Surg. 2016;38:1-6. https://doi.org/10.1186/s40902-016-0083-z.
  • Ma J, Jiang H, Liang L. Interpositional arthroplasty versus reconstruction arthroplasty for temporomandibular joint ankylosis: A systematic review and meta-analysis. J Craniomaxillofac Surg. 2015;43(7):1202-1207. https://doi.org/10.1016/j.jcms.2015.04.017.
  • Wu J. Gap arthroplasty versus interpositional arthroplasty for temporomandibular joint ankylosis: a Meta-analysis. Chin J Tissue Eng Res. 2017;21(20):3216. https://doi.org/10.3969/j.issn.2095-4344.2017.20.017.
  • Roychoudhury A, Yadav P, Bhutia O, Mane R, Yadav R, Goswami D, et al. Alloplastic total joint replacement in management of temporomandibular joint ankylosis. J Oral Biol Craniofac Res. 2021;11(3):457-465. https://doi.org/10.1016/j.jobcr.2021.05.006.
  • Kim J-Y, Kim J-Y, Jung Y-S, Nam W. Treatment of temporomandibular joint reankylosis by submandibular anchorage technique with temporalis myofascial flap. Maxillofac Plast Reconstr Surg. 2014;36(2):78. https://doi.org/10.14402/jkamprs.2014.36.2.78.
  • Kaban LB, Bouchard C, Troulis MJ. A protocol for management of temporomandibular joint ankylosis in children. J Oral Maxillofac Surg. 2009;67(9):1966-1978. https://doi.org/10.1016/j.joms.2009.03.071.
  • Zhi K, Ren W, Zhou H, Gao L, Zhao L, Hou C, et al. Management of temporomandibular joint ankylosis: 11 years' clinical experience. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;108(5):687-692. https://doi.org/10.1016/j.tripleo.2009.06.041.
  • Elgazzar R, Abdelhady A, Saad K, Elshaal M, Hussain M, Abdelal S, et al. Treatment modalities of TMJ ankylosis: experience in Delta Nile, Egypt. Int J Oral Maxillofac Surg. 2010;39(4):333-342. https://doi.org/10.1016/j.ijom.2010.01.005.
  • Holmlund A, Lund B, Weiner CK. Mandibular condylectomy with osteoarthrectomy with and without transfer of the temporalis muscle. Br J Oral Maxillofac Surg. 2013;51(3):206-210. https://doi.org/10.1016/j.bjoms.2012.05.011.
  • Kumar R, Hota A, Sikka K, Thakar A. Temporomandibular joint ankylosis consequent to ear suppuration. Indian J Otolaryngol and Head Neck Surg. 2013;65:627-630. https://doi.org/10.1007/s12070-013-0666-2.
  • Babu L, Jain MK, Ramesh C, Vinayaka N. Is aggressive gap arthroplasty essential in the management of temporomandibular joint ankylosis?—a prospective clinical study of 15 cases. Br J Oral Maxillofac Surg. 2013;51(6):473-478. https://doi.org/10.1016/j.bjoms.2012.11.004.
  • Ma J, Liang L, Jiang H, Gu B. Gap arthroplasty versus interpositional arthroplasty for temporomandibular joint ankylosis: a meta-analysis. PLoS One. 2015;10(5):e0127652. https://doi.org/10.1371/journal.pone.0127652.
  • Chidzonga M. Temporomandibular joint ankylosis: review of thirty-two cases. Br J Oral Maxillofac Surg. 1999;37(2):123-126. https://doi.org/10.1054/bjom.1997.0089.
  • Kalita F, Arunkumar K. Temporomandibular joint re-ankylosis: a case report and literature review. J Korean Assoc Oral Maxillofac Surg. 2023;49(4):218-222. https://doi.org/10.5125/jkaoms.2023.49.4.218.
  • Alqhtani NR, Alkhaldi MS, Alanazi AF, Alabdulsalam AS, Alenazi A, Zaman MU, et al. Temporomandibular Joint Space Dimensions among Saudi Patients with Temporomandibular Disorders: MRI‐Based Retrospective Study. Int J Clin Pract. 2022;2022(1):5846255. https://doi.org/10.1155/2022/5846255.
  • Kim J-Y, Kim B-J, Park K-H, Huh J-K. Comparison of volume and position of the temporomandibular joint structures in patients with mandibular asymmetry. Oral surg Oral Med Oral Pathol Oral Radiol. 2016;122(6):772-780. https://doi.org/10.1016/j.oooo.2016.08.017.

Year 2025, Volume: 15 Issue: 3, 538 - 544, 30.09.2025
https://doi.org/10.33808/clinexphealthsci.1553841

Abstract

References

  • Chouinard A-F, Kaban LB, Peacock ZS. Acquired abnormalities of the temporomandibular joint. Oral Maxillofac Surg Clin North Am. 2018;30(1):83-96. http://dx.doi.org/10.1016/j.coms.2017.08.005.
  • Al-Moraissi E, El-Sharkawy T, Mounair R, El-Ghareeb T. A systematic review and meta-analysis of the clinical outcomes for various surgical modalities in the management of temporomandibular joint ankylosis. Int J Oral Maxillofac Surg. 2015;44(4):470-482. https://doi.org/10.1016/j.ijom.2014.10.017.
  • Rozanski C, Wood K, Sanati-Mehrizy P, Xu H, Taub PJ. Ankylosis of the temporomandibular joint in pediatric patients. J Craniofac Surg. 2019;30(4):1033-1038. https://doi.org/10.1097/SCS.0000000000005547.
  • Rajurkar SG, Makwana R, Ranadive P, Deshpande MD, Nikunj A, Jadhav D. Use of temporalis fascia flap in the treatment of temporomandibular joint ankylosis: a clinical audit of 5 years. Contemp Clin Dent. 2017;8(3):347-351. https://doi.org/10.4103/ccd.ccd_1138_16.
  • Liu X, Shen P, Zhang S, Yang C, Wang Y. Effectiveness of different surgical modalities in the management of temporomandibular joint ankylosis: a meta-analysis. Int J Clin Exp Med. 2015;8(11):19831. .
  • Mittal N, Goyal M, Sardana D, Dua J. Outcomes of surgical management of TMJ ankylosis: A systematic review and meta-analysis. J Craniomaxillofac Surg. 2019;47(7):1120-1133. https://doi.org/10.1016/j.jcms.2019.03.029.
  • De Meurechy NK, Loos P-J, Mommaerts MY. Postoperative physiotherapy after open temporomandibular joint surgery: A 3-step program. J Oral Maxillofac Surg. 2019;77(5):932-950. https://doi.org/10.1016/j.joms.2018.12.027.
  • Çakarer S, Isler SC, Yalcin BK, Diracoglu D, Uzun A, Sitilci T. Autogenous dermis-fat graft in temporomandibular joint ankylosis surgery. Ann Maxillofac Surg. 2018;8(1):162-165. https://doi.org/10.4103/ams.ams_179_17.
  • Dhabale GS, Bhowate RR, Bhowate R. Cone-beam computed tomography for temporomandibular joint imaging. Cureus. 2022;14(11). https://doi.org/10.7759/cureus.31515.
  • Cho J-W, Park J-H, Kim J-W, Kim S-J. The sequential management of recurrent temporomandibular joint ankylosis in a growing child: a case report. Maxillofac Plast Reconstr Surg. 2016;38:1-6. https://doi.org/10.1186/s40902-016-0083-z.
  • Ma J, Jiang H, Liang L. Interpositional arthroplasty versus reconstruction arthroplasty for temporomandibular joint ankylosis: A systematic review and meta-analysis. J Craniomaxillofac Surg. 2015;43(7):1202-1207. https://doi.org/10.1016/j.jcms.2015.04.017.
  • Wu J. Gap arthroplasty versus interpositional arthroplasty for temporomandibular joint ankylosis: a Meta-analysis. Chin J Tissue Eng Res. 2017;21(20):3216. https://doi.org/10.3969/j.issn.2095-4344.2017.20.017.
  • Roychoudhury A, Yadav P, Bhutia O, Mane R, Yadav R, Goswami D, et al. Alloplastic total joint replacement in management of temporomandibular joint ankylosis. J Oral Biol Craniofac Res. 2021;11(3):457-465. https://doi.org/10.1016/j.jobcr.2021.05.006.
  • Kim J-Y, Kim J-Y, Jung Y-S, Nam W. Treatment of temporomandibular joint reankylosis by submandibular anchorage technique with temporalis myofascial flap. Maxillofac Plast Reconstr Surg. 2014;36(2):78. https://doi.org/10.14402/jkamprs.2014.36.2.78.
  • Kaban LB, Bouchard C, Troulis MJ. A protocol for management of temporomandibular joint ankylosis in children. J Oral Maxillofac Surg. 2009;67(9):1966-1978. https://doi.org/10.1016/j.joms.2009.03.071.
  • Zhi K, Ren W, Zhou H, Gao L, Zhao L, Hou C, et al. Management of temporomandibular joint ankylosis: 11 years' clinical experience. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;108(5):687-692. https://doi.org/10.1016/j.tripleo.2009.06.041.
  • Elgazzar R, Abdelhady A, Saad K, Elshaal M, Hussain M, Abdelal S, et al. Treatment modalities of TMJ ankylosis: experience in Delta Nile, Egypt. Int J Oral Maxillofac Surg. 2010;39(4):333-342. https://doi.org/10.1016/j.ijom.2010.01.005.
  • Holmlund A, Lund B, Weiner CK. Mandibular condylectomy with osteoarthrectomy with and without transfer of the temporalis muscle. Br J Oral Maxillofac Surg. 2013;51(3):206-210. https://doi.org/10.1016/j.bjoms.2012.05.011.
  • Kumar R, Hota A, Sikka K, Thakar A. Temporomandibular joint ankylosis consequent to ear suppuration. Indian J Otolaryngol and Head Neck Surg. 2013;65:627-630. https://doi.org/10.1007/s12070-013-0666-2.
  • Babu L, Jain MK, Ramesh C, Vinayaka N. Is aggressive gap arthroplasty essential in the management of temporomandibular joint ankylosis?—a prospective clinical study of 15 cases. Br J Oral Maxillofac Surg. 2013;51(6):473-478. https://doi.org/10.1016/j.bjoms.2012.11.004.
  • Ma J, Liang L, Jiang H, Gu B. Gap arthroplasty versus interpositional arthroplasty for temporomandibular joint ankylosis: a meta-analysis. PLoS One. 2015;10(5):e0127652. https://doi.org/10.1371/journal.pone.0127652.
  • Chidzonga M. Temporomandibular joint ankylosis: review of thirty-two cases. Br J Oral Maxillofac Surg. 1999;37(2):123-126. https://doi.org/10.1054/bjom.1997.0089.
  • Kalita F, Arunkumar K. Temporomandibular joint re-ankylosis: a case report and literature review. J Korean Assoc Oral Maxillofac Surg. 2023;49(4):218-222. https://doi.org/10.5125/jkaoms.2023.49.4.218.
  • Alqhtani NR, Alkhaldi MS, Alanazi AF, Alabdulsalam AS, Alenazi A, Zaman MU, et al. Temporomandibular Joint Space Dimensions among Saudi Patients with Temporomandibular Disorders: MRI‐Based Retrospective Study. Int J Clin Pract. 2022;2022(1):5846255. https://doi.org/10.1155/2022/5846255.
  • Kim J-Y, Kim B-J, Park K-H, Huh J-K. Comparison of volume and position of the temporomandibular joint structures in patients with mandibular asymmetry. Oral surg Oral Med Oral Pathol Oral Radiol. 2016;122(6):772-780. https://doi.org/10.1016/j.oooo.2016.08.017.
There are 25 citations in total.

Details

Primary Language English
Subjects Oral and Maxillofacial Surgery
Journal Section Articles
Authors

Canseda Avağ 0000-0002-6180-9159

Emre Tosun 0000-0003-4441-9818

Hakan Tuz 0000-0002-3883-2406

Early Pub Date September 30, 2025
Publication Date September 30, 2025
Submission Date September 21, 2024
Acceptance Date June 24, 2025
Published in Issue Year 2025 Volume: 15 Issue: 3

Cite

APA Avağ, C., Tosun, E., & Tuz, H. (2025). Evaluation of The Gap Volume Following Temporomandibular Joint Ankylosis Surgery: A Preliminary Study. Clinical and Experimental Health Sciences, 15(3), 538-544. https://doi.org/10.33808/clinexphealthsci.1553841
AMA Avağ C, Tosun E, Tuz H. Evaluation of The Gap Volume Following Temporomandibular Joint Ankylosis Surgery: A Preliminary Study. Clinical and Experimental Health Sciences. September 2025;15(3):538-544. doi:10.33808/clinexphealthsci.1553841
Chicago Avağ, Canseda, Emre Tosun, and Hakan Tuz. “Evaluation of The Gap Volume Following Temporomandibular Joint Ankylosis Surgery: A Preliminary Study”. Clinical and Experimental Health Sciences 15, no. 3 (September 2025): 538-44. https://doi.org/10.33808/clinexphealthsci.1553841.
EndNote Avağ C, Tosun E, Tuz H (September 1, 2025) Evaluation of The Gap Volume Following Temporomandibular Joint Ankylosis Surgery: A Preliminary Study. Clinical and Experimental Health Sciences 15 3 538–544.
IEEE C. Avağ, E. Tosun, and H. Tuz, “Evaluation of The Gap Volume Following Temporomandibular Joint Ankylosis Surgery: A Preliminary Study”, Clinical and Experimental Health Sciences, vol. 15, no. 3, pp. 538–544, 2025, doi: 10.33808/clinexphealthsci.1553841.
ISNAD Avağ, Canseda et al. “Evaluation of The Gap Volume Following Temporomandibular Joint Ankylosis Surgery: A Preliminary Study”. Clinical and Experimental Health Sciences 15/3 (September2025), 538-544. https://doi.org/10.33808/clinexphealthsci.1553841.
JAMA Avağ C, Tosun E, Tuz H. Evaluation of The Gap Volume Following Temporomandibular Joint Ankylosis Surgery: A Preliminary Study. Clinical and Experimental Health Sciences. 2025;15:538–544.
MLA Avağ, Canseda et al. “Evaluation of The Gap Volume Following Temporomandibular Joint Ankylosis Surgery: A Preliminary Study”. Clinical and Experimental Health Sciences, vol. 15, no. 3, 2025, pp. 538-44, doi:10.33808/clinexphealthsci.1553841.
Vancouver Avağ C, Tosun E, Tuz H. Evaluation of The Gap Volume Following Temporomandibular Joint Ankylosis Surgery: A Preliminary Study. Clinical and Experimental Health Sciences. 2025;15(3):538-44.

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