Oral Sphere
Journal of Dental and Health Sciences
Journal of Dental and Health Sciences
Received: 2025-10-11
Accepted: 2026-01-20
Published: 2026-04-01
Pages: 85-91
Background: Temporomandibular joint (TMJ) ankylosis is a form of debilitating condition that causes the fusion of the TMJ resulting in limited movement of the jaw. The use of treatment methods such as surgery and non-surgery has proven to contain different results in the cases of a given ankylosis depending on the severity of the ankylosis. The proposed research is aimed at comparing the efficacy of both surgical and non-surgical modalities of treatment of TMJ ankylosis in terms of jaw mobility, pain relief, facial symmetry and patient satisfaction.
Methods: The comparative study has been carried out on 120 patients with TMJ ankylosis, who were divided into two groups; 60 patients treated using surgery and 60 patients treated using non-surgery. The data related to the jaw mobility, level of pain, facial symmetry and patient satisfaction were measured at the baseline and after 6 months, 1 and 2 years of treatment. To compare the two treatment groups using statistical analysis, paired t -tests and independent t -tests were used to determine the differences.
Results: The surgical group thus showed significantly better improvements in jaw movement (35mm vs 18mm), range (42% vs 22%), pain relief (reduction in VAS score 7.521 vs 7.334) and facial symmetry (85% vs 60%). The surgical cohort also had higher levels of patient satisfaction (8.7 versus 6.5). However, there were complications like ankylosis recurring and weakness of the facial nerves in the surgical group, but the non-surgical group needed further interventions in some cases.
Conclusion: TMJ ankylosis surgical interventions produce better results in regard to customer satisfaction, pain alleviation, symmetrical facial form, and jaw range compared to non-surgical interventions. Non-surgical treatments are effective in the mild cases but could not result in adequate improvements in patients with severe ankylosis. The individualized treatment based on a specific severity of the condition is suggested to guarantee the best patient outcomes.
Temporomandibular joint (TMJ) ankylosis refers to abnormal bone fusion of the temporomandibular joint and thus it leads to limitation or complete inhibition of mandibular movement [1]. The given pathology can be paralysing, causing a significant level of discomfort and making speech, mastication, and breathing more complex [2]. TMJ ankylosis is normally induced by trauma, infection, or developmental anomalies and it can also affect individuals of all ages, but the severe forms result in a complete loss of mandibular activity [3].
TMJ ankylosis pathophysiology The formation of fibrous or osseous bridges between the temporomandibular joint articular surfaces occurs progressively. In the long-term, it will result in the immobilization of joints, and ankylosis may be mild to severe [4]. It is most common among the pediatric and young adult patients and usually occurs after traumatic experiences like fractures of the mandibular or condylar neck. TMJ ankylosis might also be caused by osteomyelitis and systemic diseases, such as rheumatoid arthritis or ankylosing spondylitis [5].
The case of TMJ ankylosis depends on the level of the disease clinically. Several patients show limited mouth opening which inhibits both nutritional consumption and articulation of speech. Other symptoms are facial deformities, reduced or missing mandibular movements, local pain and oral hygiene complications [6]. In severe situations, patients can exhibit visible asymmetry of the face which can be explained by progressive ankylotic process. Additionally, the psychological effects of this condition may be immense, including physical and emotional well-being of the infected person [7].
TMJ ankylosis management has been an issue of discussion in oral and maxillofacial surgery. Therapeutic modalities are generally divided into two broad categories, which include surgical and non-surgical modalities [8]. The use of these strategies depends on the severity of ankylosis, the age of a patient, and etiological factors. Non-surgical treatment is typically applied to mild ankylosis in which function of the joints is generally intact, and it may involve physical therapy, splint therapy, and pharmacologic treatment of pain and inflammation. There are situations when non-surgical treatment can be insufficient and surgical intervention is required [9].
TMJ ankylosis can be surgically treated by simple arthroplasty (removal of fibrous or osseous ankylotic tissue), or more complex interventions like total joint replacement, which may involve the use of bone grafts or prosthetic reconstruction [10]. Restoration of mandibular mobility, improvement of functional outcomes, and remediation of cosmetic deformities have been identified as the major goals of surgical intervention [11]. However, these re-surgery operations are associated with some risks, such as ankle relapse, nerve damage to face, and scarring. As such, the choice and time of surgery is a crucial factor with regard to success in therapy [12].
The recent technological advances in the area of surgical methods, such as the use of arthroscopy and computer-assisted surgery, have enhanced the results and alleviated the complications [13]. Besides, in recent years, the popularity of non-surgical therapies, i.e. rehabilitative programs focus on mandibular exercises and movements of the temporomandibular joint have increased, which is a less invasive intervention with a smaller risk scenario [14].
With the variability of clinical manifestations, and the possibility of severe functional and aesthetic outcomes, an individual and multidimensional solution to the treatment of TMJ ankylosis is extremely necessary [15].
Thus, this research aims to determine the comparative effectiveness of surgery and non-surgery in the treatment of temporomandibular joint ankylosis. The systematic comparison of the results of the research involving these forms of therapy is expected to produce substantial information about which treatment method has better outcomes in terms of restoring mandibular movements, reducing pain, increasing facial symmetry, and patient satisfaction. The findings that will be obtained are expected to guide clinical decisions, optimize the treatment plans of temporomandibular joint ankylosis, and, eventually, improve the quality of life of the affected patients.
The current study was based on the comparative research design that was focused on analyzing the results of surgical and non-surgical forms of treatment of temporomandibular joint (TMJ) ankylosis. The mixed-methods approach was the one that was chosen, incorporating both quantitative and qualitative approaches, to allow making a comprehensive evaluation of the treatment effectiveness.
The target population included patients diagnosed with TMJ ankylosis at an age of 18 to 60 years and who had been treated in one of the identified oral and maxillofacial surgery centres. Purposive sampling was used to select the participants by set inclusion and exclusion criteria. The inclusion criteria included patients who wore a unilateral or bilateral TMJ ankylosis either with or without a previous intervention and gave an informed consent to take part. The exclusion criteria included patients with congenital defects or other major comorbid conditions that may affect the mobility of the mandible such as severe arthritis or neurological conditions.
Sample Size:
The size of the sample used in this study was determined using the main outcome variable of the mandibular mobility augmentation using an effect size that was extrapolated using the available literature on the interventions designed to address the temporomandibular joint ankylosis. The power analysis, which was done through the use of known statistical programs (e.g. G-power) was done to establish a sufficient cohort size to identify differences that are clinically significant between the surgical and the non-surgical treatment cohort. Given an assumed standardized effect size of 0.5 (representative of a medium effect), a 0.05 α -level, and a desired power of 0.80, the calculated minimal per arm N was 50 and the resulting sample size was 100. This would provide enough power to identify differences in mandibular mobility, analgesic performance, facial patterns, and patient satisfaction among the two procedures.
To counter the effects of attrition and missing data, the sample size was increased by 20% with the final prospective enrollment of 60 participants per arm, or 120 overall. It is hoped that this expanded group will protect statistical power and increase the strength of inferential conclusions.
Pragmatic considerations were also included in the ultimate sample requirement, such as the availability of eligible subjects at the oral and maxillofacial surgery center and ethical considerations that will be used on the recruitment of the subjects. Enrolment was done based on pre-stipulated inclusion and exclusion criteria in order to make the study population representative of people who had the affliction of TMJ ankylosis.
Surgical Treatment Group: This cohort was assigned to subjects who were surgically treated. Surgical interventions were open arthroplasty, condylectomy, reconstruction of the joint using bone grafts, or the replacement of the joint using prostheses. The definite procedure evolved according to the extent of ankylosis, the age of the patient and recommendation by a clinician.
Non-Surgical Treatment Group: This group included patients under the conservative treatment such as physical therapy (i.e., jaw exercises, splint therapy), pharmacological treatment (i.e., non-steroid anti-inflammatory drugs as analgesics), and temporomandibular joint mobilisation. Non-surgery treatment was also mostly provided to patients with mild ankylosis or considered unfit to undergo surgery. Data Collection: Acquisition of data entailed both the clinical evaluation and patient-reported outcomes.
Pre-Treatment Assessment: Baseline data were measured before the start of treatment, including demographics (age, gender), clinical history, severity of ankylosis, and baseline measurements of mandibular range of motion.
Post-Treatment Evaluation: The follow-up data received were at different time points such as immediately following the treatment to get the immediate outcomes, and at 6 months, 1 year, and 2 years follow-up of the treatment. Follow-up analysis consisted of clinical measurement of mandibular movements, pain levels, and facial symmetries. The validated tools that were incorporated in patient-reported outcome measures (PROMs) included the TMJ Disability Index (TDI) and the Visual Analog Scale (VAS) used in measuring pain. These tools helped to assess the functional performance of the TMJ ankylosis and the role of interventions in the eyes of the patient.
The following were the main outcome measures:
Jaw Mobility: Clinical assessments of maximum mouth opening, assessed using clinical measurements, such as maximum interincisal distance (MID) and range of motion (ROM) of the TMJ.
Pain Relief: Evaluated with the help of VAS on the intensity of pain, and compared pre- and post-treatment scores were done.
Facial Symmetry: Clinical evaluation of the face and symmetry, using and using the comparison of pre-treatment and post-treatment photographs.
Patient Satisfaction: Ascertained through a structured questionnaire on perception of functional improvement and quality of life.
Among the secondary outcomes included the occurrence of complications such as ankylosis recurrence, facial nerve damage, and other operative sequelae in the surgical group and the need of further operations in the non-surgical group.
Data Analysis: The statistical programs (SPSS or similar platform) were used to process quantitative information. Descriptive statistics were a summary of demographic characteristics. Paired t -tests were used to compare primary outcomes within a group and independent t -tests were used to compare between groups; a p -value less than 0.05 indicated statistical significance.
Thematic analysis of qualitative data based on patient satisfaction surveys was used which revealed common themes about perceived benefits and obstacles related to each mode of treatment.
Ethical Considerations: The research was ethical and met the medical research standards and guidelines. Informed consent was taken by all the participants in written form before enrollment. All patient information was kept confidential, and the ethics review board of the institution approved the study protocol hence protecting the welfare of the participants.
Limitations: The small size of a sample and the difficulties in controlling all possible confounding factors, including patient compliance and different variations of surgical technique, could be noted as the prominent limitations of the study. Also, since etiologies and severity of TMJ ankylosis is heterogeneous, care should be taken in extrapolating the results to the general population of patients.
The current paper examined findings to compare the efficacy of surgery and non-surgery forms of treatment of the temporomandibular joint (TMJ) ankylosis. There was collection of data on jaw mobility, pain relief, facial symmetry and patient satisfaction. The changes were observed in both cohorts and an improvement, but the statistically significant difference between two treatment methods appeared.
The maximum interincisal distance (MID) and range of movement (ROM) of the TMJ was the main measure of jaw movement. The surgical group recorded statistically significant improvement in both MID and ROM in comparison to the non-surgical group. Particularly, the average improvement of the MID in the surgical group was 35mm, and in the non-surgery group, the average was 18mm (p‛ less than 0.05). Similarly, the ROM also increased by an average of 42 percent in the surgical group as opposed to 22 percent in the non-surgical group (p <0.01) Table 1,2.
The VAS was assessed before and after the therapy under the degree of pain. In the group of surgery, the VAS score dropped to 2.1 out of 7.5, meaning that the analgesia was significant. There was moderate amelioration in the non-surgical cohort where the reduction was 7.3 to 3.4. The difference between the inter-group relief of pain was statistically significant (p 0.01) Table 3.
Facial symmetry was rated through clinical photography which was taken before and after the treatment. The surgical group was found to have a significant improvement with 85 percent reporting that there were definite aesthetic improvements. On the contrary, 60% of the patients in non-surgical group reported small improvement, with less noticeable changes.
The facial symmetry difference in the improvement between the groups was found to be statistically significant (p < 0.05) Table 4.
The measure of satisfaction was done using a structured questionnaire graded using a scale of 1 to 10. The surgical group gave 8.7 as an average score of the satisfaction, and the non-surgical group had an average score of 6.5. This was a statistically significant difference ( p 0.05) Table 5.
Both cohorts had had adverse events. Surgical group records 10⁻ of recurrence of ankylosis and 5 percent suffered temporary weakness of the facial nerve. In the non-surgical category, 15 percent had to undergo further surgery due to the lack of jaw mobility improvement Table 6.
| Group | Pre-Treatment (mm) | Post-Treatment (mm) | Improvement (mm) | p-value |
|---|---|---|---|---|
| Surgical Group | 20.4 | 55.4 | 35 | < 0.05 |
| Non-Surgical Group | 22.5 | 40.5 | 18 | < 0.05 |
| Group | Pre-Treatment (%) | Post-Treatment (%) | Improvement (%) | p-value |
|---|---|---|---|---|
| Surgical Group | 45 | 87 | 42 | < 0.01 |
| Non-Surgical Group | 48 | 70 | 22 | < 0.05 |
| Group | Pre-Treatment VAS | Post-Treatment VAS | Improvement in Pain | p-value |
|---|---|---|---|---|
| Surgical Group | 7.5 | 2.1 | 5.4 | < 0.01 |
| Non-Surgical Group | 7.3 | 3.4 | 3.9 | < 0.05 |
| Group | Percentage of Patients with Improvement (%) | p-value |
|---|---|---|
| Surgical Group | 85 | < 0.05 |
| Non-Surgical Group | 60 | < 0.05 |
| Group | Pre-Treatment Satisfaction (Average Score) | Post-Treatment Satisfaction (Average Score) | p-value |
|---|---|---|---|
| Surgical Group | 5.2 | 8.7 | < 0.05 |
| Non-Surgical Group | 5.0 | 6.5 | < 0.05 |
| Group | Recurrence of Ankylosis (%) | Facial Nerve Weakness (%) | Additional Interventions (%) | p-value |
|---|---|---|---|---|
| Surgical Group | 10 | 5 | 0 | < 0.05 |
| Non-Surgical Group | 0 | 0 | 15 | < 0.05 |
The current research shows that surgical treatment of temporomandibular joint (TMJ) ankylosis significantly outperforms non-surgical options in improving the range of motion, reducing pain, restoring the facial balance and the satisfaction of the patients. The results are consistent with the past study such as those of Rikhotso et al. (2024) [16] that have emphasized the effectiveness of surgical treatment when TMJ ankylosis has severe manifestations. However, non-surgical treatment is also effectively used with patients with milder disease or patients where surgery cannot be performed.
There was much enhancement in jaw mobility in the surgical group, and mostly in maximal interincisal distance (MID) and total range of motion (ROM). This result is in line with study by Golthi MMK et al. (2025) [17], surgeries like open arthroplasty or joint replacement induce functionality in ankylosed TMJs. On the other hand, the non-surgical group had less dramatic results and this fact supports previous research by T Rückschloß et al. (2023) [18] showing slower results with the application of conservative treatment, such as physical therapy and splinting to produce full jaw function (. Non-surgical treatments bring about an advantage to mild ankylosis, but they do not compare in mobility restoration under the operation.
The reduction in pain was significantly higher in the surgical group which was reflected in the reduction of the Visual Analog Scale (VAS) score by 7.5 to 2.1. This finding aligns with those of DH Madhuri et al. (2024) [19], who found that there is a substantial reduction in pain after the surgical management of TMJ ankylosis. Though even the non-surgical cohort received pain relief, the level of the relief was rather comparatively low. The given outcome confirms the assumption that surgery does not just recover functional capacity but also offers long-term relief against the disabling pain that comes with TMJ ankylosis. Administration of non-surgical modalities although effective in alleviating pain to some degree, might fail to correct the structural pathology of the joint leading to less effective long term pain relief.
Facial asymmetry is a common outcome of TMJ ankylosis especially at an advanced stage. There was a significant increase in the facial symmetry of the surgical group, which supports the literature that accentuates the aesthetic benefits of joint reconstruction. Ankylosis surgical repair not only improves the results of the procedure, but also restores the aesthetics of the face, which is an important variable affecting the psychological wellbeing of the patients. The non-surgical group experienced a slight gain on facial symmetry but the outcome was not as salient like the other previous study by Gulsen A et al. (2018) [20] which have shown that the non-surgical technique is not so effective in enhancing the facial look.
Greater satisfaction rates were identified with the surgical group, which is consistent with M Ibrahim et al. (2024) [21] as more patient satisfaction was noted after surgical therapy on TMJ ankylosis. Unequivocal outcomes are expected to be positive in surgical interventions in terms of functional and aesthetic outcome, which will help to increase patient satisfaction in general.
Conversely, lower levels of satisfaction were observed in the non-surgical group because a significant number of people still reported functional impairment and pain, which is why it is important to consider the individualized treatment planning depending on the severity of the disease and the expectations of the patient.
This study has few limitations that should be considered when interpreting the findings. The relatively small sample size, although sufficient for detecting significant differences, may limit the generalizability of the results. Additionally, the study was conducted at a single institution, which may not be representative of all patient populations with TMJ ankylosis, and the results may not be applicable to different geographical or socioeconomic groups. The reliance on subjective patient-reported outcome measures, such as pain relief and satisfaction, introduces the potential for bias, as these are influenced by individual perceptions and emotional factors. Furthermore, variations in surgical techniques within the surgical treatment group could introduce confounding factors, affecting the consistency of the outcomes. While the study included follow-up assessments at multiple time points, a longer follow-up period would be needed to capture long-term efficacy and complications. The exclusion of patients with significant comorbidities, such as rheumatoid arthritis or neurological disorders, limits the applicability of the findings to those with more complex medical histories. The study also relied on clinical photographs and manual measurements for assessing facial symmetry and jaw mobility, which are subject to observer variability, and more advanced imaging techniques could provide more accurate data. Additionally, cultural and psychological factors, which may influence patient-reported outcomes, were not systematically assessed. Despite these limitations, the study provides valuable insights into the relative effectiveness of surgical and non-surgical treatments for TMJ ankylosis and lays the groundwork for future research that could address these challenges.
To sum up, the current study supports the hypothesis that surgery on temporomandibular ankylosis has a better effect compared to nonsurgical treatments, especially in the aspects of mandibular movements, nociceptive relievers and aesthetic appearance. However, non-surgery treatments still have a consequential role to play in the treatment of the mild presentation. In order to select the most appropriate treatment method, clinicians are also recommended to conduct a careful assessment of ankylosis severity, clinical profile of the individual patient, and his/her preferences concerning the treatment method.
