CASE REPORT

Atraumatic Temporomandibular Joint Ankylosis: A Case Report

Noyomi Saring1, Luksi Jilen2, Tumbi Lollen3
Received on: 04 May 2025; Accepted on: 09 June 2025; Published on: 18 August 2025

A b s t r ac t
F ibrous or bony adhesion of temporomandibular joint (TMJ) leading to temporomandibular joint ankylosis (TMJA) can lead to limitation or
inability to open the mouth, causing difficulty or inability to mastication, speaking, or maintaining oral hygiene, and ultimately leading to growth
restriction of affected joint as well as general habitus. This is a case report of an adult patient of 35 years who had been challenged with TMJA for
17 years following acute toothache and pus discharge from jaw at teenage (13 years). The patient has been treated with bilateral gap arthroplasty
with ipsilateral flap graft, along with left coronoidectomy and active postoperative physiotherapy. The study concludes that an ankylosis of TMJ
may be successfully treated with surgical intervention with grafting with active physiotherapy at any time the ailment is diagnosed.
Keywords: Ankylosis, Arthroplasty, Case report, Coronoidectomy, Temporomandibular joint.
TRIHMS Medical Journal (2025): 10.5005/tmj-11033-0003

Introduction 1
Department of Anaesthesiology, Tomo Riba Institute of Health and
The temporomandibular joint (TMJ) is a ginglymoarthrodial synovial Medical Sciences, Naharlagun, Arunachal Pradesh, India
joint that forms between the glenoid fossa (mandibular fossa) of the 2,3
Department of Dentistry, Tomo Riba Institute of Health and Medical
temporal bone and the mandibular condyle, and its articular surface Sciences, Naharlagun, Arunachal Pradesh, India
is lined by fibrocartilaginous disc. It is an essential part of opening Corresponding Author: Noyomi Saring, Department of
and closing of jaw and facial movement.1 Temporomandibular Anaesthesiology, Tomo Riba Institute of Health and Medical Sciences,
joint ankylosis (TMJA) is defined as “bony/fibrous adhesion of the Naharlagun, Arunachal Pradesh, India, Phone: +91 9436227174,
anatomic joint components accompanied by a limitation in opening e-mail: drnaomisaring@[Link]
the mouth, causing difficulties with mastication, speaking and oral How to cite this article: Saring N, Jilen L, Lollen T. Atraumatic
hygiene as well as inadvertently influencing mandibular growth.”2 Temporomandibular Joint Ankylosis: A Case Report. Trihms Med J
This, in turn, leads to physical growth restriction due to malnutrition 2025;2(1):26–28.
and mental or emotional complexities. Source of support: Nil
Incidence of TMJA is most commonly due to trauma (31–98%), Conflict of interest: Dr Noyomi Saring is associated as the Associate
followed by local or systemic infection (10–49%), and lastly any Editor of this journal and this manuscript was subjected to this
systemic disease (10%).3 The uncommon causes include arthritis journal’s standard review procedures, with this peer review handled
(ankylosing spondylitis, rheumatoid arthritis, or psoriasis), congenital independently of this editorial board member and his research group.
deformities, previous TMJ surgery, and iatrogenic causes. Other Patient consent statement: The author(s) have obtained written
causes include infection of any kind like otitis media or mastoiditis informed consent from the patient for publication of the case report
or from the hematogenous route—tuberculosis, gonorrhea, scarlet details and related images.
fever, etc.3,4 The current case presentation is uncommon TMJA post-
osteomyelitis of the mandible, which caused gradual fibrosis of joint
and finally lead to inability to open the mouth. were found to be carious, with tilted left molars. The gingiva of left
side jaws was merged.
C a s e P r e s e n tat i o n The radiological examination revealed reduced joint space in
A 35-year-old female presented to the Department of Dentistry with left TMJ and fusion of alveolar bones on left with displaced molar
difficulty to open the mouth for last 17 years. The problem occurred tooths (36 number tooth was completely tilted lingually) as shown
gradually in term of years, which started when she was 13 years old in CT image in Figure 1C. The case was diagnosed as ankylosis of
(22 years ago) with acute toothache with swelling on left side of the left TMJ and left alveolar bone of maxilla and mandible following
jaw. Initially there was pus discharge from same area of jaw. In the osteomyelitis of alveolar bone with displaced molar tooths.
years that followed, the patient noticed a hole in the affected area The patient was counseled, and disorder was agreed to be
which caused expulsion of food from the bony part of the mandible managed surgically under general anesthesia with postoperative
without pain. The hole closed by itself, and the toothache subsided. physiotherapy. The TMJ was exposed using Alkayat-Bramley
But the patient started having gradual difficulty in opening the incision as shown in Figures 2 and 3, and fibrous and bony ankylosis
mouth for eating and drinking, which ultimately lead to inability to of left TMJ (Sawney classification type I) was found. Thereafter,
open the mouth. There was no history of illness like tuberculosis, the release of ankylosis was performed using Kaban’s protocol
rheumatic arthritis, psoriasis, or any kind of surgery. (Figs 2B and C).
On examination, there was total occlusion of mouth opening Left gap arthroplasty could achieve only 17 mm interincisal gap
as shown in Figure 1B. A scar was seen on left cheek (Fig. 1A), (Fig. 4A); thus, bilateral gap arthroplasty was done which achieved
which was left behind from the discharging sinus. All the molars interincisor gap of 37 mm (Fig. 4B). Bilateral autogenous graft of

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 Temporomandibular Joint Ankylosis following Infection

Figs 1A to C: (A) Scar on left cheek; (B) Occluded mouth opening; and (C) Computed tomography of TMJA

Figs 2A to C: (A) Incision line; (B) Buccal exposure; and (C) Intraoral exposure

in single sitting. The fusion of alveolar process of left maxilla and

mandible were found at second molar region up to maxillary
tuberosity to the retromolar region of mandible. Coronoidectomy
of only affected ipsilateral left side was performed.
Mouth opening of 27 mm on third postoperative day
(Fig. 4C) was followed by active mouth opening physiotherapy.
The interincisor gap increased to approximately 30 mm in 3 months
(Fig. 4D). The carious tooths were treated conservatively.

Discussion
Stiff TMJ is one of the most common disorders of facial skeleton,
which tends to be undermanaged especially in children. The case
may present with impaired speech, impaired mandibular and
Figs 3A and B: (A) Autologous temporal flap graft is lifted; and (B) Flap maxillary bone growth, deuterating dental hygiene with painless
graft is placed in the position of gap arthroplasty gradual occlusion of mouth opening which may go unnoticed.5
Early diagnosis and treatment are the crucial management strategy
temporal myofascial tissue was raised from both sides and placed for such cases; otherwise it may lead to impaired speech, impaired
in gap arthroplasty, creating 10−15 mm gap between glenoid fossa mastication leading to malnutrition, disfiguration of face, and
and ramus as an interpositional flap to prevent future re-ankylosis compromised upper airway.

TRIHMS Medical Journal, Volume 2 Issue 1 (January–June 2025) 27

 Temporomandibular Joint Ankylosis following Infection

Figs 4A to D: Comparison of interincisor gap of the patient. (A) 17 mm after left gap arthroplasty; (B) 37 mm after bilateral gap arthroplasty;
(C) 27 mm at third postoperative day; and (D) 30 mm after active physiotherapy of 3 months

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