An 11-year-old patient, following trauma to the jaw as an infant, developed a worsening facial asymmetry and now has extreme limitations in opening. He has no other joint problems in the body.

The problem is localised to a single joint in the body and has a clear relationship to trauma when an infant, so ankylosis seems a likely diagnosis and juvenile chronic arthritis seems unlikely. Bony ankylosis means that mandibular movement is essentially non-existent, although a few millimetres of movement may be observed through flexing of the bone. Sometimes, however, the ankylosis is due to fibrous union of the joint components, and a little greater movement may be possible. Radiography should be able to differentiate the two types.

RESEARCH CORNER

Bony ankylosis in an 11-year-old individual can be caused by trauma. Trauma-induced bony ankylosis has been reported in various studies (Rikhotso & Nkonyane, 2017; Dhupar et al., 2018; Gomes et al., 2017).

For example, Rikhotso & Nkonyane (2017) reported a case of bony ankylosis in an 11-year-old resulting from untreated zygomatic arch fracture when the patient was 2 years old (Rikhotso & Nkonyane, 2017).

Similarly, Gomes et al. (2017) stated that trauma is responsible for a significant proportion of cases of ankylosis (Gomes et al., 2017).

Additionally, young trauma patients are more likely to develop more severe types of ankylosis (Xia et al., 2019).

Therefore, the occurrence of bony ankylosis in an 11-year-old individual can be attributed to trauma experienced in infancy.

References

Dhupar, V., Akkara, F., Khandelwal, P., Louis, A. (2018). Zygomatico-coronoid Ankylosis As Sequel Of Inadequate Treatment. Ann Maxillofac Surg, 1(8), 158. https://doi.org/10.4103/ams.ams_107_15 Gomes, A., Pereira, G., Santos, Í., Matos, J., Franco, J., Santos, M., … & Neto, I. (2017).

Ankylosis Due Sequel Of Fracture Of the Mandibular Condyle: Case Report. int arch med, (10). https://doi.org/10.3823/2507 Rikhotso, R., Nkonyane, M. (2017).

Zygomatico-coronoid Ankylosis: a Case Report. OJST, 11(07), 475-480. https://doi.org/10.4236/ojst.2017.711043 Xia, L., An, J., He, Y., Xiao, E., Chen, S., Yan, Y., … & Zhang, Y. (2019).

Association Between the Clinical Features Of And Types Of Temporomandibular Joint Ankylosis Based On A Modified Classification System. Sci Rep, 1(9). https://doi.org/10.1038/s41598-019-46519-8