In this case report, we present the surgical intervention and follow-up management in the treatment of a 40-year-old male who was struck by a motor vehicle and suffered life-threatening complications, including bilateral condylar fractures. Twelve years after the trauma occurred, the patient was referred to the department of Orofacial Pain & Dysfunction, seeking a conservative treatment for his jaw pain, progressive limitation of mouth opening, facial deformity, and lack of dental care. A full orofacial pain workup revealed bilateral TMJ ankylosis. His passive maximum interincisal opening was measured at 15 mm with a hard end feel. The history of his present illness, physical exam, and radiographic examination confirmed the working diagnosis of bilateral temporomandibular joint ankylosis. Therefore, conservative treatment was ruled out, and he was referred to the department of Oral & Maxillofacial Surgery.
The planned surgical intervention included bilateral TMJ gap arthroplasty with interposition abdominal adipose tissue graft and bilateral coronoidotomies.
The rehabilitation phase included musculoskeletal care and pharmacological treatment with non-steroidal anti-inflammatory drugs for heterotopic bone formation prophylaxis. After the surgery and rehabilitation support, the patientÂ’s maximum inter-incisal distance is reproducible at 38 mm. At this time, the patient is pain-free. This case report demonstrates that the positive outcome of a multidisciplinary phase-wise treatment can be achieved through a combination of a surgical phase, an intensive jaw physical therapy and pharmacological treatment in the postsurgical period. This clinical experience may be considered as an additional contribution to medical literature specific to this pathological condition.
Key words: Temporomandibular joint, TMJ ankylosis, orofacial pain, physical therapy, TMJ arthroplasty
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