Amarjeet Gambhir
Temporomandibular joint ankylosis is one of the most exasperating handicaps affecting human beings that cause problems in mastication, speech, digestion, appearance & hygiene. Surgical correction of ankylosis involves a variety of procedures ranging from gap arthroplasty & interposition arthroplasty (with or without distraction osteogenesis) to total joint reconstruction. Interpositional arthroplasty has become the mainstay of treatment nowadays as it possibly reduces recurrence and also maintains ramus height to certain extent. Though over the years, the technique for releasing temporomandibular joint ankylosis seems to have been standardized, high recurrence rate is a persistent problem bothering patients as well as surgeons. A variety of materials such as dermal grafts, auricular cartilage, costochondral graft, temporalis muscle and/or fascia flap and fascia lata have been used following surgical release of ankylosis with variable amount of success. Over the years, a pedicled temporalis myofascial flap has given consistently good results when used as an interpositioning material following release of ankylosis. It has the advantage that its arc of rotation can be altered by basing the flap inferiorly or posteriorly. Additionally, its dependable blood supply and proximity to temporomandibular joint make it a versatile flap for lining the glenoid fossa. The muscle and fascia are of adequate thickness, and the long term viability of the flap has also been demonstrated. The temporalis myofascial flap satisfies most of the requirements of an ideal interpositioning material following release of ankylosis. Its excellent blood supply, close proximity to the joint, versatility, ease of handling and minimal donor site morbidity is the characteristics which make it an effective interpositioning material to be used for management of TMJ ankylosis.
