A systematic review and meta-analysis of the clinical outcomes for various surgical modalities in the management of temporomandibular joint ankylosis

A systematic review and meta-analysis was performed to assess the clinical outcomes of the following four methods for the management of temporomandibular joint (TMJ) anlcylosis: gap arthroplasty (GA), interpositional gap arthroplasty (IPG) using the temporalis muscle, reconstruction of the TMJ using a costochondral graft (CCG), and alloplastic joint reconstruction (AJR) of the TMJ. A comprehensive electronic and manual search of the literature without date or language restriction was performed in December 2013 to identify randomized controlled trials, controlled clinical trials (CCTs), and retrospective studies with the aim of comparing the four surgical modalities for TMJ anlcylosis. Sixteen publications were included: seven were CCTs and nine were retrospective. A significant difference was found between GA and IPG in maximal inter-incisal opening (MIO) and recurrence rate (P = 0.04 and P = 0.02, respectively).. A significant difference was found between IPG and CCG reconstruction in MIO (P = 0.01), but no significant difference with regard to the recurrence rate (P = 0.71). There was a significant difference between costochondral joint (CO) and AIR for MIO and pain (P = 0.04 and P = 0.03, respectively). The results of the meta-analysis showed that IPG results in a significant improvement in MIO and lower recurrence rate when compared to GA. Also, IPG shows a greater improvement in MIO and comparable recurrence rate when compared to CCG reconstruction. GA and CCG reconstruction have a comparable recurrence rate. Lastly, CCJ provides greater MIO when compared to AIR, whereas AJR is superior to CCJ in reducing pain.