양측성 완전 악관절 강직의 교정을 위한 Ohara Condylar Prosthesis의 14년의 관찰

Abstract

Temporomandibular joint(TMJ) ankylosis is a serious and disabling condition. It results in the inability of the patient to open the mouth, impairment of the speech, difficulty in mastication, poor oral hygiene, facial asymmetry, mandibular micrognathia and psychologic disability. The causes of TMJ ankylosis can be diverse, traumatic, septic, autoimmune and rarely neoplastic. Traumas and particularly mandibular condyle fracture represent the most frequent cause of TMJ ankylosis. The interposition of muscle and fascia between the bones and many other materials like cartilage, muscle and dermis, fat or fascia was suggested.1 In addition, numerous alloplastic materials have been used for partial or total reconstruction of the TMJ. The current authors report 14 years follow-up results of Ohara condylar prosthesis for the treatment of bilateral temporomandibular joint ankylosis in a 35-year-old male. The patient had a bilateral TMJ ankylosis and micrognathia resulted from rheumatoid arthritis and the TMJ reconstruction with Ohara condylar prosthesis was performed. Four years later, right Ohara prosthesis was removed due to the penetration of the prosthesis into the middle cranial fossa and right TMJ was reconstructed with vascularized calvarial bone graft and costo-chondral graft. At 13 years after the first operation, reankylosis occurred bilaterally, and gap arthroplasty with interpositional silicon block was performed. Now he is being encouraged to exercise to open the mouth and opening up to 30mm is possible.