Interpositional arthroplasty versus reconstruction arthroplasty for temporomandibular joint ankylosis: A systematic review and meta-analysis
Introduction
Temporomandibular joint ankylosis (TMJA) is the functional disability of the mandible, caused by the fibrous or bony adhesion among the condyle, disc, glenoid fossa, and eminence (Long et al., 2005). Trauma is the most common etiologic factor, documented in 13%–100% cases of TMJA. Local or systemic infection is the second most common etiology. In rare circumstances, systemic diseases, such as ankylosing spondylitis, rheumatoid arthritis, and psoriasis, may also lead to TMJ ankylosis (Chidzonga, 1999, Vasconcelos et al., 2009).
TMJA causes functional impairment in mastication and speech; in addition, it poses a severe threat to facial development in children. In unilateral cases, TMJA can cause hypoplasia of the mandible and deviation to the affected side. In bilateral cases, a typical bird-face appearance with retrognathia, mandibular alveolar protrusion, and open bite may appear (Güven, 2008).
Currently, the following three techniques are most often used: gap arthroplasty (GA); interpositional arthroplasty (IA); and reconstruction arthroplasty (RA). However, none of these three techniques has been accepted as a universally successful method for various type of TMJA. Reankylosis is the most common and troubling postoperative complications encountered in clinical practice.
GA is the oldest type of surgery for treating TMJA; however, due to the high incidence of recurrence and malocclusion caused by shortened mandibular ramus, its application is becoming limited, and some authors have even suggested abandoning GA (Kaban et al., 1990, Matsuura et al., 2001). Currently, IA and RA are more popular, especially for children with TMJA. Although successful application of IA and RA have been widely reported, direct comparison between RA and IA is rare and results are controversial, which leads to a dilemma for surgeons when choosing certain treatment modalities (Sahoo et al., 2012).
Therefore we conducted this systematic review and meta-analysis to compare the outcomes of IA and RA to provide some evidence-based suggestions for clinicians.
Section snippets
Literature search
The PubMed, EMBASE, OVID EBM Reviews, and Web of Science were searched up to October 11, 2014, using the following key words with combinations: temporomandibular joint, TMJ, ankylosis, interpositional arthroplasty, interposition arthroplasty; joint reconstruction, articulation reconstruction, joint replacement, autogenous graft, alloplastic graft, costochondral graft. The references lists of included studies were also manually searched.
Inclusion criteria and quality assessment
The inclusion criteria were as follows: randomized
Study characteristics
The selection process is shown in Fig. 1. Eight studies with a total of 234 patients were included in this meta-analysis (Balaji, 2003, Manganello-Souza and Mariani, 2003, Qudah et al., 2005, Tanrikulu et al., 2005, Erol et al., 2006, Elgazzar et al., 2010, Loveless et al., 2010, Sahoo et al., 2012). All of these were retrospective cohort studies; no RCT was found. The clinical characteristics and the methodological qualities of these studies are listed in Table 1.
Temporalis myofascial flap
Discussion
In this meta-analysis of 8 studies, we compared the outcomes of IA and RA. Pooling the data did not reveal any significant differences in the incidence of reankylosis and MIO between IA and RA. Based on this result, and after taking technique difficulty and donor site morbidity into consideration, we believe that IA seems to be superior over RA in treating TMJA. However, this conclusion should be drawn cautiously, especially for children, because the differences in facial development after IA
Conclusion
No significant differences between IA and RA regarding reankylosis and MIO were detected by the present meta-analysis; reankylosis occurred in both groups. Wide surgical exposure, complete resection, early mobilization, aggressive physiotherapy, and good patient compliance are all indispensible to guarantee the success of surgery. Other clinical outcomes, including postoperative occlusion, growth of CCG, and growth of the mandible, need more thorough evaluation.
Funding
None.
Financial disclosure
None.
Conflict of interest
None.
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