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Diagnosis and Management of TMJ Heterotopic Bone and Ankylosis

Larry M. Wolford

Introduction

Temporomandibular joint (TMJ) heterotopic bone refers to calcifications that develop in and around areas of the joint that are normally void of the bone. The development of heterotopic bone within the confines of a joint or in the surrounding area can cause joint dysfunction, pain, as well as progression to ankylosis. Temporomandibular joint ankylosis is a condition where the condyle is fused to the fossa by bony or fibrotic tissues creating a debilitating condition that can interfere with jaw function, mastication, speech, oral hygiene, growth and development, breathing, and normal life activities and cause pain. There are numerous surgical techniques that have been proposed to manage heterotopic bone and TMJ ankylosis with varying outcomes reported. The most common complications following the treatment of ankylosis are limited jaw function, pain, and re-ankylosis.

Etiology

The formation of TMJ heterotopic bone and ankylosis is most commonly caused from trauma but can also be related to inflammation or bone growth stimulation related to various TMJ pathologies such as infection, reactive arthritis, osteoarthritis, inflammatory conditions, connective tissue/autoimmune diseases (e.g., juvenile idiopathic arthritis, rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, scleroderma, etc.), endocrine and metabolic disorders, multiply operated joints,

L.M. Wolford, DMD

Department of Oral and Maxillofacial Surgery, Texas A&M University College of Dentistry, Dallas, TX, USA

Department of Orthodontics, Texas A&M University College of Dentistry, Dallas, TX, USA e-mail: This email address is being protected from spam bots, you need Javascript enabled to view it

© Springer International Publishing AG 2017

G.F. Bouloux (ed.), Complications of Temporomandibular Joint Surgery, DOI 10.1007/978-3-319-51241-9_9

foreign-body giant-cell reaction, repeated injections of medications into the TMJ (i.e., steroids), as well as unsuccessful previous TMJ surgeries including failed TMJ autogenous grafts and alloplastic implants. Heterotopic bone in the initial phase may be asymptomatic, but with further development can create pain, decrease range of motion, and may lead to ankylosis. A variable amount of fibrosis and reactive tissue are normally associated with heterotopic bone, thereby worsening the adverse effects.

Bleeding into a joint by trauma or a surgical procedure as well as the presence of dead space following extensive TMJ debridement or reconstruction with autogenous bone or total joint prosthesis can lead to blood clot formation in the joint area, with subsequent organization. Pluripotential cells can then migrate into the area and differentiate into fibroblasts and osteoblasts, with deposition of collagen and then bone, respectively. This results in the potential for developing heterotopic bone and ankylosis. In excessively fibrotic joints, there is also a decrease in tissue vascularity with a resultant decrease in oxygen tension in the surrounding tissue. This can lead to the transformation of fibrous tissue into cartilage and bone with potential for ankylosis [1]. Temporomandibular joint ankylosis can be even more devastating in growing patients resulting in a profound dentofacial deformity in addition to jaw dysfunction and malocclusion.

 
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