Pseudo-ankylosis of the temporo-mandibular joint (TMJ)
refers to a persistent restricted mandibular hypomobility
resulting from a pathologic condition outside the TMJ.
Ankyloses may be acquired or congenital. Most congenital
ankyloses are extracapsular (pseudo- ankyloses), while most
of the acquired ankyloses (true ankyloses) are intracapsular.
An extremely rare form of extracapsular ankylosis is bony
pterygomandibular fusion, few cases having been reported
in the literature. To our knowledge, a case with two separate
ipsilateral extracapsular ankylosis sites together with bilateral
intracapsular ankylosis has never been reported. This paper
considers the case of a 24 year-old patient who had been
unable to open his mouth for six years. There was neither a
history of trauma nor one of recurrent infection. The patient
presented with a slight facial asymmetry with deviation of the
mandible towards the right. CT scans confirmed the diagnosis
of a complex pseudoankylosis, characterised by unilateral
bony fusions between the lateral pterygoid plate and the
medial aspect of the ramus, coronoid process and zygoma
together with bilateral intracapsular ankyloses. The patient
underwent surgery for ostectomy of the pterygomandibular
fusion and a bilateral coronoidectomy. Comments on a
paediatric case with bilateral bony pterygomandibular
fusions are also included.