Outcomes of surgical management of TMJ ankylosis: A systematic review and meta-analysis

Background: Temporomandibular joint (TMJ) ankylosis can be surgically managed by a number of approaches. This systematic review compared the clinical outcomes among various treatment options, i.e., gap arthroplasty (GA), interpositional gap arthroplasty (IGA), reconstruction arthroplasty (RA) and distraction osteogenesis (DO). Methods: PubMed, Ovid, Embase, Web of Science, Scopus and Cochrane central register of controlled trials were searched till April 2018. Randomized controlled trials, cohort studies and retrospective studies in subjects with acquired TMJ ankylosis reporting re-ankylosis with a follow-up period of >12 months were included. Results: Twenty-six studies with 1197 subjects were included. The higher recurrence rate was observed with GA compared to both IGA and RA (p < 0.05). Comparable results were obtained with IGA, RA and DO (p > 0.05). Among interpositional materials, alloplastic materials showed higher recurrence rate compared to autogenous materials (p < 0.05). However, for reconstruction, both autogenous grafts and alloplastic prosthetic implants gave similar results (p > 0.05). The highest improvements in MMO (maximum mouth opening) resulted with IGA but the differences regarding post-operative changes in MMO were clinically similar in all other groups. Conclusion: IGA with autogenous material and reconstruction using either autogenous grafts or total joint replacement by alloplastic prosthetic implants provide similar clinical outcomes for TMJ ankylosis management. (C) 2019 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.