Full thickness mucoperiosteal flap was reflected and the ankylotic mass was exposed.
(1) aggressive resection of the ankylotic segment, (2) ipsilateral coronoidectomy, (3) contralateral coronoidectomy when necessary, (4) lining of the joint with temporalis fascia or cartilage, (5) reconstruction of the ramus with a CCG, (6) rigid fixation of the graft, and (7) early mobilization and aggressive physiotherapy.
Sometimes localized ankylotic
areas can be removed and the integrity of the ligament restored when periodontal ligament fibroblasts or their progenitors are allowed to gain access to the root and repopulate the area.
Surgical approach to the TMJ was Al-Kayat and Bramley and for joint capsule T-shaped incision used, after approaching to joint ankylotic
mass was cut and at least 10mm gap created between the ramus and base of skull and finally temporalis myofascial flap was used as interpositional graft material.
The aim in the treatment of TMJ ankylosis is the complete surgical resectioning of ankylotic
bone, aggressive exercises to prevent recurrence, ensuring functional occlusion and dental rehabilitation.18 The techniques employed to that end are joint reconstructions performed with costochondral grafts or alloplastic joint prostheses, gap arthroplasty and interpositional arthroplasty.
Topazian compared gap and interpositional arthroplasties, reported 53 Percent recur- rence in patients treated by gap arthroplasty but no recurrence was observed when autogenous tissue was interposed.22 However, other studies on gap arthro- plasty and the present study show better results of gap arthroplasty.23,24 This may be due to complete removal of the medial ankylotic
mass and having carried out postoperative physiotherapy strictly.