The mouth hardly opens
A narrow gap remains between the teeth. In a series of 521 fused joints, the mouth opened an average of 5.4 mm before surgery.
CONDITION / JAWS, MOUTH AND NECK
Ankylosis of the temporomandibular joint.
Ankylosis of the temporomandibular joint is a fusion of the jaw joint with the skull by bone or scar tissue, due to which the mouth barely opens or does not open at all. It is treated with surgery, and after it, regular development of the jaw is important so that the fusion does not return.
CONCEPTUAL VISUALIZATION- What it is
- The mandibular joint is fused to the skull with bone or scar tissue.
- Causes
- The most common is an injury, followed by an infection.
- Why not delay
- In children, ankylosis prevents the growth of the jaw and can disrupt breathing during sleep.
- Who treats it
- A maxillofacial surgeon together with an anesthesiologist and a rehabilitation specialist.
01 / WHAT IS ITWhat is
What is
ankylosis of the joint.
The temporomandibular joint is the joint in front of the ear where the lower jaw moves when you open your mouth, chew, and speak. With ankylosis, the head of the jaw grows with the articular fossa of the skull by bone or dense scar (fibrous) tissue.
This makes it difficult to chew, speak and brush your teeth. And in an emergency situation, the fused joint becomes dangerous: it is difficult for doctors to ensure breathing when the mouth does not open.
Bone ankylosis occurs more often than fibrous ankylosis, and unilateral - more often than bilateral. If the joint grew during childhood, the jaw on this side grows worse: asymmetry, a small lower jaw appear, and sometimes breathing stops during sleep.
This page is about a fused joint. If the head of the joint is gradually destroyed and the bite changes, and the mouth opens at the same time, this is another condition.
This is general information. The doctor will tell you what will suit you after the examination.
02 / SIGNSHow
How
ankylosis presents.
The main symptom is that the mouth opens less and less. In children, facial and breathing changes are added to it over time.
It is difficult to chew and speak
You have to eat bland food, it is difficult to take care of your teeth and mouth.
Asymmetry and small jaw
If ankylosis occurred in childhood, the jaw is underdeveloped, the chin shifts or "runs" back.
Asymmetry of the face and jawsSnoring and breathing pauses in sleep
Loud snoring, pauses in breathing, snoring or choking in sleep are possible signs of obstructive sleep apnea, which can accompany ankylosis with an underdeveloped jaw.
03 / REASONSWhy joint
Why joint
is growing
Most often, ankylosis is the result of an injury, often in childhood. The authors of one of the studies suggest that ankylosis is more common where little is known about it and a fresh injury is initially treated incorrectly.
Injury
The most common cause of ankylosis. In a survey of 1,607 children at one specialist center in India, 128 cases of ankylosis were found, and the main cause was trauma during childbirth or during childhood.
Fractures of the condylar processInfection
The second most frequent cause after trauma.
Autoimmune diseases
Joint fusion is also a consequence of autoimmune diseases.
Congenital or after operations
In a series of 28 children with congenital facial defects, ankylosis in 9 was congenital, in 16 it occurred after previous operations on the jaw, in 3 — after infection.
Reasons in old age
In a series of 28 patients (mean age, 51.8 years), who received an artificial joint, ankylosis was after trauma in 39%, after arthrosis in 32%, and congenital in 25%.
04 / SEEK MEDICAL ADVICE
When to seek medical advice?
Chronic ankylosis usually does not require emergency care - it is treated as planned. But due to the fused joint, it is more difficult to help a person if he is suffocating, so you should warn doctors about ankylosis in advance.
103 immediately if:
- it is very difficult to breathe: a person suffocates, chokes or cannot utter words;
- lips or skin become very pale, bluish, gray or mottled;
- the person is confused, speaks indistinctly or does not make sense;
- the child breathes hard: croaks or the stomach sinks under the ribs when inhaling;
- after a blow to the head, a person faints and does not regain consciousness;
- convulsions began after a blow to the head;
- after a blow, a clear liquid flows from the nose or ear;
- bleeding does not stop after surgery;
- after surgery, the swelling in the mouth or neck increases rapidly, it becomes difficult to swallow or breathe.
Other levels of urgency:
Immediately - to the surgeon who operated, and if it does not work - to the waiting room: after the operation, the pain increases, the wound becomes red, swollen or pus is released from it, a fever appears. The same day to the doctor: the mouth suddenly stopped opening or the jaw jammed; you cannot eat or drink; after a blow to the chin or face, it hurts in front of the ear and the mouth does not open completely - especially in a child. Planned: the mouth opens less and less over the months; the child snores loudly and stops breathing in his sleep; the jaw grows asymmetrically.
05 / DIAGNOSTICSAs defined,
As defined,
that grew
- Discussion and review
When the mouth began to open worse, were there injuries or infections. The doctor measures how many millimeters the mouth opens.
- CT
A CT scan shows where and how the joint has fused—with bone or scar tissue—and how the jaw has changed.
- Sleep examination
If there is snoring and breathing pauses, especially in a child with a small jaw, check breathing in sleep.
- Review of an anesthesiologist
The mouth does not open, so they plan in advance how to safely ensure breathing during anesthesia.
06 / TREATMENTHow they are fired
How they are fired
the joint
The goal of treatment is to restore jaw movements, correct facial deformity, reduce pain, and prevent re-union. All of the methods that the reviews compare are surgical; exercises complement surgery, not replace it.
01
Release of the joint
The fused area is removed to allow the jaw to move again.
- Gap between bones (gap arthroplasty)
- Splices are cut out and leave a gap. Whether ankylosis returns more often after that, meta-analyses answer differently: in one (26 studies, 1197 patients) — more often than with padding or joint reconstruction, in another (8 studies, 272 patients) no difference was found.
- Padding from own fabrics
- Their own tissue is placed in the gap — a fascia with a temple muscle or a skin-fat graft. The mouth then opened an average of about 1.2–2 mm more than after a simple gap (2015 and 2022 meta-analyses). Autologous tissue as a spacer produced fewer re-unions than artificial materials.
- In children
- In a review of 24 series (176 patients under 18 years of age), a simple spacer and a spacer gave a similar result; repeated fusion — in 4 out of 176 (2.27%). The authors emphasize exercises after surgery.
02
Restoration of the joint
When the head is removed together with the fusion, the branch of the jaw is restored.
- Own bone
- Most often — a rib with cartilage or a process of the jaw itself. According to a meta-analysis of 35 studies (700 patients), reunion was about 8%, with maxillary process - in 2.98%.
- Rib growth in a child
- A transplanted rib can grow unpredictably: in a review of 95 patients under the age of 18, there was insufficient growth in 22.11%, excessive growth in 13.70%, facial asymmetry in 20%.
- Artificial joint
- Fusions are removed and a prosthesis of the fossa and head is placed - mostly in adults. In a series of 28 patients (median follow-up 11.5 years), mouth opening, pain, and quality of life improved significantly, ankylosis returned in one; facial nerve dysfunction was in 32.1%.
- What to choose
- According to a 2019 meta-analysis, own bone and prosthesis gave similar results. In another meta-analysis, the mouth opened more with a rib joint and less pain with a prosthesis.
03
When the jaw is underdeveloped
- Protruding the jaw
- If ankylosis, a small jaw, and sleep apnea are combined, joint release is combined with gradual lengthening of the bone by an apparatus (distraction) — simultaneously or in stages. In a review of 34 studies (360 patients), the jaw was advanced 6–34 mm, and sleep breathing improved in all studies; the level of evidence is low.
04
After surgery
- Development of the jaw
- Mouth-opening exercises and devices are an essential part of treatment: a review of 31 studies suggests that physical therapy is necessary to improve outcome and reduce the risk of re-union.
- Data from one center
- In a series of 521 joints operated on in one hospital, the mouth opened an average of 36.9 mm one year after the operation; temporary weakness of facial muscles was 14.78%, there was no permanent paralysis; ankylosis returned in 8.82%.
- Complex cases in children
- In children with congenital facial defects, ankylosis often returns: in a series of 28 children, 75%, many required repeated operations.
07 / AT THE VALIKHNOVSKYI INSTITUTE
How
How
we treat it.
Ankylosis of the temporomandibular joint is treated at Dr. Valikhnovskyi's Institute of Surgery in the "New Face" direction - in the "Lower Jaw and Joint" area, along with fractures and reconstruction of the jaws.
CLINIC SERVICE
A new face
Form, symmetry, facial expressions and functions after injuries, wounds, burns, removal of tumors and congenital changes.
View service
What we do for this condition
- CT and 3D planning — they build a three-dimensional model using computer tomography and plan in advance what to remove and what to restore; the undamaged side is mirrored on the affected side.
- Surgical templates — printed guides, along which the bone is sawn at a given angle.
- Joint implant — an artificial joint, when its own head cannot be preserved.
- Individual implants — plates or fragments of the jaw made of medical titanium or PEEK according to the 3D model, which repeat the anatomy of the patient.
- Rehabilitation of mouth opening — exercises to develop the jaw after surgery.
Rostislav Valikhnovskyi
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.
How treatment works with us
- Pictures onlineSend a CT scan, if available, a photo of the face and describe how the mouth opens - the doctor will pre-evaluate the situation.
- ConsultationExamination, measurement of mouth opening, CT scan; if necessary, a sleep examination.
- PlanHow to free a joint and how to restore it; in a child - taking into account the growth of the jaw.
- SurgeryUnder general anesthesia; the anesthesiologist plans in advance how to ensure breathing.
- RecoveryDaily exercises to open the mouth and follow-up examinations to detect the return of the fusion in time.
08 / QUESTIONS AND ANSWERSCommon
Common
questions
Short answers. What is right for you, the doctor will tell you during the consultation.
Can ankylosis be cured without surgery?
The main treatment is surgery: all the methods that the reviews compare are surgical. Exercises and devices for developing the jaw are needed after it to maintain the result.
Can ankylosis return?
Yes, this is the main risk. In a series of 521 joints, ankylosis returned in 8.82%, in a meta-analysis of own grafts - in about 8%. That is why exercises after surgery are so important.
How much will the mouth open after surgery?
Depends on the method and exercises. In a series of 521 joints — an average of 36.9 mm after a year; according to a meta-analysis of transplants, the mouth opened 27–31 mm more than before surgery.
What is better — your own bone or an artificial joint?
There is no unequivocal answer. According to the 2019 meta-analysis, the results are similar. A child's rib can grow unpredictably, so a prosthesis is more often considered for adults. The method is chosen based on age, CT and the condition of the jaw.
When to operate a child?
The doctor determines the terms individually. Ankylosis interferes with the growth of the jaw and can disrupt breathing in sleep, so the plan is made taking into account growth, breathing and bite.
Will facial asymmetry be corrected?
If the jaw is underdeveloped, one release of the joint may not be enough: the jaw is pushed out or aligned - at the same time or at a later stage.
Why warn doctors about ankylosis?
Because the mouth does not open, and in an emergency situation or during anesthesia, it is more difficult to ensure breathing. This is planned in advance.
Sources
21 sources · reviews, meta-analyses, research and NHSshowCollapse
- Management of temporomandibular joint ankylosisOral and Maxillofacial Surgery Clinics of North America, 2015doi:10.1016/j.coms.2014.09.003 ↗
- Outcomes of surgical management of TMJ ankylosis: A systematic review and meta-analysisJournal of Cranio-Maxillofacial Surgery, 2019doi:10.1016/j.jcms.2019.03.029 ↗
- A systematic review and meta-analysis of the clinical outcomes for various surgical modalities in the management of temporomandibular joint ankylosisInternational Journal of Oral and Maxillofacial Surgery, 2015doi:10.1016/j.ijom.2014.10.017 ↗
- Gap Arthroplasty versus Interpositional Arthroplasty for Temporomandibular Joint Ankylosis: A Meta-AnalysisPLOS ONE, 2015doi:10.1371/journal.pone.0127652 ↗
- Comparison of surgical outcomes related to interpositional arthroplasty materials used in patients with temporomandibular joint ankylosis: a systematic review and meta-analysisBritish Journal of Oral and Maxillofacial Surgery, 2022doi:10.1016/j.bjoms.2022.05.005 ↗
- Autogenous grafts for reconstruction arthroplasty in temporomandibular joint ankylosis: a systematic review and meta-analysisBritish Journal of Oral and Maxillofacial Surgery, 2022doi:10.1016/j.bjoms.2022.05.012 ↗
- Long term complications of costochondral graft reconstruction in temporomandibular joint ankylosis of the young — a systematic reviewJournal of Stomatology, Oral and Maxillofacial Surgery, 2023doi:10.1016/j.jormas.2023.101437 ↗
- Ankylosis of the Temporomandibular Joint in Pediatric PatientsJournal of Craniofacial Surgery, 2019doi:10.1097/SCS.0000000000005547 ↗
- Triad of temporomandibular joint ankylosis, micrognathia, and obstructive sleep apnoea: a systematic review of surgical managementBritish Journal of Oral and Maxillofacial Surgery, 2024doi:10.1016/j.bjoms.2024.08.003 ↗
- The role of physiotherapy interventions in the management of temporomandibular joint ankylosis: a systematic review and meta-analysisHead & Face Medicine, 2024doi:10.1186/s13005-024-00416-2 ↗
- Temporomandibular joint ankylosis: A tertiary center-based epidemiological studyNational Journal of Maxillofacial Surgery, 2021doi:10.4103/njms.NJMS_57_20 ↗
- Temporomandibular Joint Ankylosis Release: 17 Years of Experience with 521 JointsJournal of Maxillofacial and Oral Surgery, 2019doi:10.1007/s12663-018-1115-2 ↗
- Temporomandibular Joint Ankylosis: Long-Term Outcomes with One-Stage Resection and Reconstruction Using Total Joint Alloplastic Replacement — A 20-Year ExperienceJournal of Clinical Medicine, 2025doi:10.3390/jcm14134639 ↗
- Temporomandibular Joint Ankylosis in Pediatric Patients With Craniofacial Differences: Causes, Recurrence and Clinical OutcomesJournal of Craniofacial Surgery, 2020doi:10.1097/SCS.0000000000006328 ↗
- Alloplastic total joint replacement in management of temporomandibular joint ankylosisJournal of Oral Biology and Craniofacial Research, 2021doi:10.1016/j.jobcr.2021.05.006 ↗
- Temporomandibular disorder (TMD)NHS, 2023nhs.uk/conditions/temporomandibular-disorder-tmd ↗
- Shortness of breathNHS, 2024nhs.uk/symptoms/shortness-of-breath ↗
- Head injury and concussionNHS, 2025nhs.uk/conditions/head-injury-and-concussion ↗
- Sleep apnoeaNHS, 2026nhs.uk/conditions/sleep-apnoea ↗
- Cuts and grazesNHS, 2026nhs.uk/conditions/cuts-and-grazes ↗
- SepsisNHS, 2026nhs.uk/conditions/sepsis ↗
The figures on the page are from these sources.
No mouth
opens?
Send CT scan if available and photo of face. The doctor will tell you what can be done and where to start.