Anquilose da articulação temporomandibular unilateral na infância: um relato de caso clínico e revisão integrativa da literatura

Abstract

This study aims to perform an integrative review of the literature on temporomandibular joint ankylosis in childhood and the different forms of treatment, as well as to report a case of a patient who was affected by this pathology, describing the planning, surgical approach and follow-up. A 12-year-old patient, with a main complaint of limited mouth opening, with no history of previous trauma, was referred by the pediatric team of the Varela Santiago Children's Hospital for evaluation and management by the Oral and Maxillofacial Surgery and Traumatology (CTBMF) area of UFRN. The patient underwent a unilateral gap arthroplasty in the left joint region and total choroinectomy on the same side, and her joint was reconstructed with a costochondral graft and interposed autogenous fat. The primary objective of the treatment was to restore mouth opening, to ensure adequate nutritional support for her development and to enable adequate oral hygiene and dental treatment. As a secondary goal, we sought to ensure some unilateral growth of the mandible, since the asymmetry was already significant. The treatment proved to be effective, achieving the primary and partially the secondary objective, and the patient is being monitored for possible future orthognathic surgery after her growth is complete. The integrative literature review aimed at analyzing the results found on the treatments of temporomandibular joint ankylosis in childhood used the Pubmed/Medline, LILACS, Scopus and Web of Science databases with the keywords “Ankylosis”, “Temporomandibular joint” and “Pediatrics”, present in the Health Sciences Descriptors (DeCS), with the Boolean operator AND, in “advanced search” mode, published between the years 2014 to 2024. The data found corroborate the conduct of the case report, since there are numerous statements that pediatric patients with Unilateral Temporomandibular Joint Ankylosis present good responses to treatment with greater range of mouth opening, when submitted to reconstructions with costochondral grafts covered by autogenous adipose tissue. Therefore, we believe that although re-ankylosis is not uncommon in these cases, the use of fat may represent a factor that influences the formation of heterotopic bone and consequently favors the reduction of relapses.