Tracheostomy in temporomandibular joint ankylosis – A review of the literature and case report

Background

Temporomandibular joint (TMJ) ankylosis is a challenging clinical entity and management is primarily surgical. Patients with neurological conditions such as epilepsy may be prone to frequent joint dislocations or trauma over their lifetimes. They may also undergo surgeries to prevent recurrent joint dislocation that may increase the risk of TMJ ankylosis. Epileptic patients represent a population in which treatment of TMJ ankylosis, particularly bilateral ankylosis, can be complicated by difficult airway or medical management in the postoperative period. Tracheostomy is not often required for airway management in patients undergoing total joint replacement for bilateral TMJ ankylosis but may be a useful surgical adjunct to increase treatment safety in certain patient populations. A multi-disciplinary approach to anti-epileptic medication management is also beneficial given potential difficulties with oral intake in patients with TMJ ankylosis.

Methods

A systematic review of the literature was undertaken for evaluation of available literature using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). A representative case example was provided for consideration.

Results

Review of the available literature resulted in no articles addressing the potential utilization of tracheostomy in patients with TMJ ankylosis. A variety of literature is available for patients with craniofacial anomalies who may require tracheostomy and who may develop TMJ ankylosis from a young age, but no literature is available to provide evidenced-based treatment guidelines for adult patients with ankylosis who may be at increased risk for airway compromise. Medical management of patients with refractory seizure activity can be difficult to optimize, and treatment regimens may require alterations during the perioperative period for patients undergoing TMJ total joint replacement.

Conclusions

Patients undergoing surgical treatment for bilateral TMJ ankylosis who also have neurological conditions such as epilepsy may be at increased risk for airway compromise during the postoperative period. Patients with difficult to control seizure activity may also be at increased risk for joint dislocation during the postoperative period of TMJ total joint replacement. Temporary tracheostomy represents a surgical option to improve patient safety in the immediate postoperative period along with appropriate medical management, and its consideration has not previously been reported for this patient population.