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A New 3-Phase Therapy Protocol in Temporomandibular Joint Ankylosis: Our Experience

Limitations in oral opening may be due either to intra-articular or extra-articular ankylosis (pseudoankylosis). The principal means of therapy usually consist of 2 steps: surgical removal of the ankylotic block and immediate functional rehabilitation. In the postoperative period, however, immediate and adequate functional rehabilitation is not always possible because of pain and swelling of the temporomandibular joint, resulting in a very high risk of relapse. To prevent this, the authors introduce a third phase between the 2 already mentioned (surgery and functional therapy) in which the oral opening obtained with surgery is held in place while clinical conditions (pain and swelling) are allowed to stabilize before initiating intensive physiotherapy. Through the discussion of 18 clinical cases (8 of which were treated in the traditional way), the authors report on the intermediate treatment phase introduced by them between the surgical stage and the rehabilitation. Immediately after the operation, a handmade wedge, that is, a bite block of suitable size, is placed between the dental arches for a period of about 3 weeks, while appropriate pharmacological therapy was administered. The results showed an improvement of the mandibular movements both in opening and laterally, on the right and left sides, in patients treated with the new protocol. The proposed protocol holds the opening obtained with surgery until the clinical conditions make it possible to initiate intensive physiotherapy. In this way, the authors obtained better results in both recovery and in mandibular movements.