Treatment for actinomycosis of the left jaw and an improved arthroplasty technique with interposition of fascia temporalis for temporomandibular joint ankylosis resulting from the inflammation are discussed. Changes in post-surgical masticatory function were noted.
The patient was a 60-year-old woman refered to this center for evaluation of gradual onset immobility of the jaw. The maximum interincisal opening was 5mm, and obstinate swelling was noted in the temporal, buccal and mandibular areas. The WBC count was 10, 000 with 82.8 percent neutrophils. She had been infected with Actinomyces, thought to have entered through a denture wound on buccal mucosa. Upon hospitalization, drainge was established by intra and extra oral incisions. Actinomyces were found in the discharged exudate which did not contain characteristic sulfur granules. Antibiotic therapy for 47 days with sulbenicillin was required for complete remission of the lesion.
The patient was rehospitalized three years later due to progressive inability in opening the jaw, and arthroplasty was performed with a diagnosis of left temporomandibular joint ankylosis due to hypertrophic arthritis caused by inflammatory reaction of actinomycosis. Using the Al-Kayat Bramley incision, partial excision of the condylar head was performed, and fascia temporalis was taken, folded and inserted into the capsule in order to prevent the recurrence of ankylosis. A satisfactory result was obtained; trismus was relieved permitting a maximum jaw opening of 40mm. One year and 9 months after the operation, jaw movement remains at 34-40mm.
Treatment of actinomycosis, the role of interposition in arthroplasty and advantages of fascia temporalis are discussed.
