Jaw joint replacement allows youth to open mouth after 8 years

A 19-year-old boy, whose jaw joint got fused to his skull base due to which he was not able to open his mouth for the past eight years, successfully underwent a Total Temporomandibular Joint (TMJ) replacement at the AIIMS here.

Shivam suffered from TMJ Ankylosis after he fell flat on his face while flying kite. The injury caused his jaw joint to fuse with the skull rendering him unable to open his mouth even half an inch.

He was barely surviving on liquids and was unable to speak since then and his condition was deteriorating day-by-day.

After a surgery at government hospital in Lucknow failed to cure Shivam, he had to turn up at the Centre for Dental Education and Research, All India Institute of Medical Sciences (AIIMS).

A team of Oral and Maxillofacial surgeons from AIIMS performed the TMJ replacement, the first case in India, on him Oct 4.

"Main goal of the total jaw joint reconstruction is to re-establish function and aesthetic. TMJ is the point of attachment of the lower jaw to the skull and it is the most complex joint of the human body. This replacement in the patient has improved his quality of life very much and he is enjoying food every day now," said Ajoy Roychoudhury, professor and head of the department of oral and maxillofacial surgery at AIIMS.

He said there are various treatment options for ankylosis like gap arthroplasty, and interpositional arthroplasty with autogenous bone graft such as ribs and sternoclavicular joint. However, the chances of recurrence are high due to poor patient compliance for postoperative oral physiotherapy or due to excessive hetrotrophic bone formation around the operated site.

According to medical experts, the causes of TMJ ankylosis are trauma or fall, ear infection and inflammation.

Ongkila Bhutia, another senior dental surgeon who was part of the surgery team, said the TMJ replacement allows reproduction of the natural anatomy, avoids donor site morbidity, reduces surgery time and lessens the risk of re-ankylosis.

Talking about TMJ replacement, Roychudhury said: "Though this joint replacement has been introduced in India now, in the west it is being done since 1995 and over 400 such surgeries have been done.

"Currently the cost of the surgery is over Rs.3 lakh for both side jaw replacement... however the cost will definitely come down with increase in the number of cases," he said.