British Journal of Oral and Maxillofacial Surgery 52 (2014) 624–628 Available online at www.sciencedirect.com Piezoelectric osteoarthrectomy for management of ankylosis of the temporomandibular joint Anson Jose a , Shakil Ahmed Nagori b , Anjali Virkhare c , Krushna Bhatt d , Ongkila Bhutia e , Ajoy Roychoudhury f,* a Resident, Department of Oral and Maxillofacial surgery, All India Institute of Medical Sciences, New Delhi, India b Resident,Department of Oral and Maxillofacial surgery, All India Institute of Medical Sciences, New Delhi, India c Resident, Department of Oral and Maxillofacial surgery, All India Institute of Medical Sciences, New Delhi, India d PhD Student, Department of Oral and Maxillofacial surgery, All India Institute of Medical Sciences, New Delhi, India e Department of Oral and Maxillofacial surgery, All India Institute of Medical Sciences, New Delhi, India f Professor and Head, Department of Oral and Maxillofacial surgery, All India Institute of Medical Sciences, New Delhi, India Received 23 October 2013; accepted 17 April 2014 Available online 22 May 2014 Abstract We describe the use of a piezoelectric osteotome for removal of bone in patients with ankylosis of the temporomandibular joint (TMJ) and its advantages over conventional techniques. We studied 35 patients with ankylosis of 62 TMJ (27 bilateral and 8 unilateral, 2 recurrent) who were treated by gap arthroplasty between 1 January 2011 and 31 December 2012. We used a preauricular, with extended temporal, incision in all cases. The ankylosis was released with a piezoelectric scalpel. There were 23 men and 12 women, mean (SD) age 16 (9) years. We noticed a substantial reduction in bleeding with the piezoelectric bone cutter compared with the dental drill, though the operating time was longer. We noticed no bleeding from the maxillary artery or pterygoid plexus. Mean (SD) bleeding/side was 43 (5) ml, and mean (SD) operating time was 77 (8) minutes for a single joint. At 6 months’ follow-up mean (SD) passive mouth opening was 35 (3) mm. Piezoelectric bone removal for the release of ankylosis of the TMJ is associated with minimal bleeding, few postoperative complications, and satisfactory mouth opening at 6 months’ follow up. © 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved. Keywords: TMJ ankylosis; Complications; Piezosurgery. Introduction The development and success of piezoelectric bone cutting has revolutionised maxillofacial surgery. It uses ultrasonic vibrations and so has selective affinity for hard tissue, and as it causes no heat it avoids any damage to the soft tissue. 1 Since its invention it has become one of the widely-practiced * Corresponding author. Professor and Head, Department of Oral and Maxillofacial surgery, Centre for Dental Education and Research, All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110029, India. Tel.: +91-11-9891007749; fax: +91-11-26589303. E-mail address: ajoyroy@hotmail.com (A. Roychoudhury). methods for creating osteotomies for distraction osteogenesis, 2 implant dentistry, 3 sinus grafting, 3 and orthognathic surgey. 4 Though there is a published consensus about the use of piezosurgery in these operations, little has been written about its use in the treatment of ankylosis of the temporomandibular joint (TMJ). Ankylosis of the TMJ is disabling, and causes prob- lems in mastication, digestion, speech, appearance, and hygiene. Among the various treatments described for it, gap arthroplasty is well-established. The operation consists of aggressive osteoarthrectomy of the ankylotic mass to cre- ate a gap of 1.5 cm, followed by aggressive physiotherapy. 5 Creating such a gap is also the most important first step for http://dx.doi.org/10.1016/j.bjoms.2014.04.012 0266-4356/© 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.