ORIGINAL ARTICLE   

European Journal of Oral and Maxillofacial Surgery 2019 April;3(1):12-6

DOI: 10.23736/S2532-3466.18.00157-1

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Study of risk factors for developing post-traumatic temporomandibular joint ankylosis

Krushna V. BHATT ¹ ✉, Ajoy ROYCHOUDHURY ¹, Ongkila BHUTIA ¹, Renu SAXENA ², Viveknandhan SUBBIAH ³, Parthaprasad CHATTOPADHYAY ⁴, Sudip SEN ⁴, Ravindra M. PANDEY ⁵

¹ Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India; ² Department of Hematology, All India Institute of Medical Sciences, New Delhi, India; ³ Department of Neurobiochemistry, All India Institute of Medical Sciences, New Delhi, India; ⁴ Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India; ⁵ Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India

BACKGROUND: Aim of the study was to test the risk factors for the development of post-traumatic temporomandibular joint (TMJ) ankylosis.
METHODS: For the present age matched case-control study, 41 cases of preoperative TMJ ankylosis patients and 36 controls of condylar fracture follow-ups were taken and the demographic details, age of onset of the disease/trauma, any associated mandibular fractures, trauma interventions received and results of the blood tests to check for procoagulant status were tabulated. Standard hematological tests were used. The data was analyzed using Pearson chi2 test and Wilcoxon rank-sum tests.
RESULTS: There were 41 cases and 36 controls. Among cases 15 were males and 26 females; in controls 28 were males and 8 females (P<0.001). Median age at the time of injury was significantly less in cases than in the controls (4 and 12 years respectively). The risk factor with highest significance was inadequate trauma care; 97.6% cases had either inadequate or no treatment at all, whereas 91.7% controls had adequate treatment; P<0.001. In 9/41 cases (21.9%) of TMJ ankylosis pro-coagulant state of blood was found as compared to only 1/36 (2.8%) controls (P=0.01).
CONCLUSIONS: Young age, female gender, bilateral condylar head fractures, inadequate treatment and hypercoagulability are pre-disposing factors for post-traumatic TMJ ankylosis. Primary trauma-care for all and further research on effects of hypoxia and activated protein C in the development of ankylosis are needed.

KEY WORDS: Temporomandibular joint - Ankylosis - Protein C - Mandibular condyle - Fractures, bone