Ankylosis of the TMJ in a 4-year-old child: three-dimensional treatment planning

Ankylosis is a disease in which bones fuse together. In this case, the activity of the joints is partially or completely blocked. In dentistry, a distinction is made between ankylosis of the TMJ (temporomandibular joint) and dental ankylosis, when the tooth fuses with the bone. Most often men are affected by it. To eliminate the disease, you should contact an orthodontist and a surgeon: the first one works to bring the bite back to normal, and the second one performs surgical treatment of TMJ ankylosis, removing abnormalities in the joint and restoring its mobility.

Ankylosis of the TMJ appears:

• after a joint injury;
• after a long period of immobility, for example, being in a cast;
• due to inflammation or purulent process;
• as a consequence of arthritis.

When a joint fusions, as a result of the destruction of the articular cartilage, a bone growth appears near it, due to which the joints are connected and become immobile. Ankylosis is accompanied by breathing problems, tongue retraction, sleep apnea, snoring, and due to periodic lack of hygiene, tartar forms. This leads to tooth decay and other oral diseases. Ankylosis of the TMJ is eliminated with a surgeon’s scalpel.

The process of fusion of articular surfaces occurs gradually - as a result of violation of the integrity of the articular cartilage, the cavity around it is overgrown with connective bone tissue (growth), which ultimately leads to complete fusion and pathological changes in the joints, creating their immobility. Treatment of ankylosis of the temporomandibular joint is performed surgically.

Symptoms

Usually the problem is typical for molars - chewing teeth. You should be alarmed by the fact that the child’s baby tooth does not fall out. Due to its fusion with the bone, it simply cannot be easily separated from the alveoli, as is normal, and remains in it.

Subsequently, the child’s jaw begins to develop incorrectly. The tooth is located noticeably lower than the others in the row, and the neighboring teeth are turned at an angle relative to it. This leads to significant bite problems and the inability to close teeth normally. Due to the lack of normal chewing load, the antagonist tooth on the opposite jaw gradually becomes loose and falls out.

Tooth ankylosis has other development options. The baby tooth may not fully erupt, as if it has slowed down in its development. Also, the growth of a baby tooth may be severely delayed, which is why a permanent tooth cannot develop normally in its place. As a result, the temporary tooth falls out, and the permanent tooth becomes fused to the jaw.

Bone ankylosis

With bony ankylosis of the TMJ, there is a connection between the condylar process and the zygomatic arch. It turns out that bone tissue fills the joint cavity. Bone ankylosis of the TMJ can be partial or complete, depending on whether there are intact areas on the surface of the joints. If the disease affects only one joint, the face becomes asymmetrical. When two joints are affected, the upper jaw moves forward, the chin region falls, which leads to malocclusion and problems with teeth, speech and breathing. A person with this condition will have difficulty eating solid food. The full form is characterized by the fact that the joint space is not visible on the x-ray, and the condylar process appears wider than it should.

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Ankylosis of the TMJ in children: causes and treatment

The occurrence of temporomandibular joint ankylosis in children can be triggered by infection in the blood of newborns, as a result of which ulcers appear in the joints and bones. Also, ankylosis can manifest itself as a consequence of injury, in which the condylar process breaks and the lower jaw dislocates, blood collects in the joint cavity and hemarthrosis occurs. Since it is impossible to receive normal food in such a situation, there is a high probability that the child will develop a general developmental delay.

Eliminating this disease is the task of orthodontists and maxillofacial surgeons. Ankylosis causes the lower jaw to remain underdeveloped and doctors have to deal with malocclusion. Doctors must lengthen the injured jaw and restore its mobility. At the same time, it is necessary to correct the bite. These measures will become the basis for further normal growth and development of the facial skeleton, restoration of full breathing and the return of normal speech and chewing.

General overview

According to research results, pathologies associated with dysfunction of the TMJ occur in patients of all age groups. Ankylosis, one of the forms of the disease associated with insufficient development of the mandibular region, is diagnosed mainly in men, and, due to its specificity, can be detected in the early stages of formation. A joint defect is associated with a violation of the aesthetic appearance, as a result of which patients consult a doctor at the first sign of a problem.

A characteristic symptom of ankylosis is the inability to fully open the oral cavity to perform basic functions, be it eating or articulation. As the pathology progresses, the limitation of mobility becomes more and more noticeable, which forces patients to limit themselves in the choice of food and ready-made meals, and also creates problems when communicating with other people. In addition, the manifestation of pathology at an early age entails deformation of the facial skeleton, accompanied by a violation of the shape of the bite and defects in the development of the dentition.

Ankylosis of the TMJ: treatment

In the early stages of TMJ ankylosis, therapeutic procedures such as ultrasound and hydrocortisone injections are used into the joints. Also, under anesthesia, redressing is performed, eliminating fibrous adhesions in the joint with the jaws moving apart under the influence of external force.

Persistent ankylosis of the TMJ can only be eliminated during surgery. Orthodontic procedures are then carried out. Surgical intervention can relieve the patient of cosmetic defects and return the lower jaw to full functionality. During the operation, special attention is paid to anesthesia, since with this disease there may be difficulties with intubation, up to the need to perform it through a tracheotomy.

To prevent the recurrence of ankylosis, the lower jaw is fixed after surgery with splints and special means, cosmetic procedures and massage of the masticatory muscles are performed. Afterwards, the patient needs to visit an orthodontist to completely correct the bite.

Predictions and prevention

With treatment and timely consultation with a doctor, the prognosis is good. But to improve the situation, additional preventive measures are required:

• mechanotherapy with dosed loads;
• physiotherapy (methods are determined by the doctor based on the results of treatment and the dynamics achieved);
• massage;
• myogymnastics.

Surgery may require additional treatment from an orthodontist. Mentoplasty is also often recommended for patients after surgery. The following situations increase the risk of complications:

• metabolic disorders in the body;
• rheumatism, gout, arthritis of various types;
• circulatory disorders.

Therefore, the Patient is required to monitor his health status, and if signs of deterioration appear, he should undergo an examination.

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Concept

Ankylosis of the TMJ involves complete or partial fusion of the joint due to fibrous or bone content. This fusion manifests itself as a complete or partial restriction when opening the patient’s mouth. The pathology occurs against the background of underdevelopment of the jaw bone, and can also provoke malfunctions of the articular joint and significant aesthetic disturbances. Most often, ankylosis develops in children or adolescents, and boys suffer from this pathology almost 2 times more often than girls. When this disease appears in children, the jaw becomes deformed, which is clearly expressed in the child’s appearance.

The human jaw is a complex machine, and the problems that can arise are not limited to tooth decay, periodontal disease, malocclusions, or frenulum frenulums.

One of the most common diseases, along with those listed, are lesions of the temporomandibular joint (TMJ). Let's talk about how to understand that the jaw has suddenly stopped being friends with us, and what to do about it.

The temporomandibular joint is an extremely mobile paired joint that connects the base of the skull with the lower jaw: intra-articular cartilage is located between the surface of the head of the mandible and the articular surface of the temporal bone. Normally, joints are involved in all movable processes simultaneously.

Some symptoms of dysfunction or disease of the TMJ are observed in at least 40% of people - this is due to the fact that we rarely use which joint in the body more often. Yawning, chewing, speaking, chattering teeth when we are cold - all this requires a certain muscle tension and coordinated work of all parts of the TMJ.

Normally, a person moving his jaw should not feel any discomfort - any unpleasant sensation, sounds, pain will be a reason to consult a doctor.

Symptoms that you should pay close attention to:

• spasms of the facial and jaw muscles, pain;
• headache, dizziness, pain and pressure in the ears and eyes;
• uncharacteristic sounds when moving: clicking, crunching, grinding;
• jamming: the jaw seems to be stuck, cannot move, or, conversely, is actively moving to the side;
• sudden change in bite;
• enlarged lymph nodes.

The main causes of TMJ diseases:

• mechanical trauma - bruises, cracks, fractures of the jaw bones;
• Bruxism - with severe stress or excessive physical activity, a symptom of involuntary clenching of teeth occurs, grinding teeth in sleep. Such loads have a bad effect on the condition of the joint;
• metabolic disorders, endocrine system dysfunction;
• previous inflammatory processes in the joint, in particular complications after the flu;
• prolonged absence of teeth or prolonged use of incorrectly selected dentures;
• habits: one-sided chewing, holding the telephone receiver with the shoulder, etc.

Of the variety of TMJ dysfunctions, the most common are the following:

• ARTHRITIS . This is an inflammatory process that develops during injuries, local infections and allergic reactions. Accordingly, a distinction is made between traumatic arthritis, non-infectious and infectious. In the acute stage, the pain is severe and becomes even more intense with the slightest movement - it is impossible to open the mouth completely, the jaw shifts. The parotid areas become swollen and edema occurs. With chronic arthritis, pain becomes moderate and occurs spontaneously. The joint becomes stiff, the parotid area becomes sensitive.

Treatment is usually conservative. For all types of disease, immobilization is used for 2–3 days using a sling bandage and a semi-liquid diet. Further on the specifics: traumatic ones are treated with cold compresses, analgesics, physiotherapy, massage and myogymnastics; acute - non-steroidal anti-inflammatory drugs (NSAIDs) and chondoprotectors, physiotherapy. For chronic cases, in addition to medications, massage courses, physiotherapy and rational dentures are prescribed. In case of purulent arthritis, the surgeon performs an emergency opening and drainage of the joint cavity.

• ARTHROSIS . This is a dystrophic disease in which the relationships of the masticatory muscles are disrupted, as they are rebuilt to overcome occlusal obstacles, for example, with low-quality and poorly fixed dentures. In such cases, a situation may arise with the appearance of unnatural chewing - due to an unevenly distributed load, one part of the joint receives excessive pressure, the other - stretching; cracks appear in the articular cartilage and it becomes deformed; bone tissue undergoes osteoporosis. The complaints characteristic of arthritis include crunching and clicking, pain during inactivity, which can radiate to the palate, throat, tongue and even shoulder.

Balance treatment. In addition to the necessary pharmaceutical prescriptions (NSAIDs, chondoprotectors) and physiotherapy, the doctor does a lot of work to find and eliminate factors leading to imbalance in the functioning of the joint and uneven load: malocclusion, poor-quality dentures - any little thing, even replacing fillings and selective grinding can help to the patient. In the later stages of arthrosis, surgical intervention may be indicated - meniscectomy, resection of the head of the lower jaw, transplantation of the articular head or complete prosthetics.

• ANKYLOSIS . It can often be a consequence of advanced arthrosis. This is a fusion of joint surfaces - fibrous (more often in adults) or bone (more often in children): the joint is partially or completely deprived of mobility in the horizontal plane. Ankylosis can appear due to chronic joint diseases, osteomyelitis, fractures, or untimely treated purulent arthritis. In addition to the fact that the jaw hardly moves, the shape of the face changes, pain and clicking occur, and the muscles quickly tire.

Treatment of fibrous ankylosis in the initial stages can be conservative - physiotherapy, intra-articular injections of hydrocortisone, redressing (separating the jaws, carried out under anesthesia; dissection of adhesions inside the joint). In complex cases and with bone ankylosis, only surgical intervention under conduction anesthesia or general anesthesia is indicated to restore the functions of the jaw and eliminate deformities of the facial bones. The surgeon performs osteotomy with arthroplasty and plastic surgery of the lower jaw using a bone autograft. During the rehabilitation period, in order to avoid relapse, the lower jaw is fixed with special splints. Patients often require mentoplasty in the future.

• DISLOCATION . The result of a violation of the position of the jaws relative to each other, usually manifests itself in muscle disorders. Many different conditions fall into this category: hypermobility of the head of the mandible, sprains and TMJ capsules. In case of subluxation or dislocation of the head of the lower jaw, in the first case the patient can restore the blocked joint himself, in the second case the help of a doctor is required.

Treated by reduction. The surgeon returns the articular heads to the articular capsules, then the lower jaw is fixed with a bandage for a period of 5–7 days, and the patient is prescribed a gentle diet. The main condition for successful rehabilitation is the time when the patient presented with the problem, since old dislocations are quite difficult to correct. In these cases, the surgeon may prescribe resection of the heads of the lower jaw.

• LESIONS OF THE ARTICULAR DISC : displacement with reduction (the disc clicks into place if you open your mouth); displacement without reduction, in which it is impossible to fully open the mouth; displacement without reduction and without restrictions. In this case, patients complain of muscle pain and tension, strange sounds, and limited mobility. Also, patients with an already established diagnosis may have no complaints at all. This condition must be monitored as it can subsequently lead to more complex lesions of the disc and the TMJ as a whole.

The condition of the jaw is very important for a person’s overall health - the inability to eat well leads to dysfunction of other organs and systems of the body, and psychological stress from ringing in the ears and clicking joints will only aggravate the problem. If you notice at least one of the symptoms, consult a doctor and solve the problem at an early stage.