Table 1 Data extraction results

Ahmad et al. (2015)/ [17]

A Prospective Comparative Study

28

Unspecified

To assess modified T-plate interpositional arthroplasty

Trauma, infection, and re-ankylosis

TMJ ankylosis causes facial deformities and reduced mouth opening. Reduced mouth opening causes malnutrition

One day after surgery, active physiotherapy began. Wooden spoons measured mouth openings and physiotherapy efficacy

The modified T-plate interpositional arthroplasty approach is practical in managing TMJ ankylosis

Bayat et al. (2009)/ [18]

Retrospective study

34

21.5

To evaluate gap and interpositional arthroplasty with temporalis muscle flap for TMJ ankylosis

Trauma and osteochondroma

Bony ankylosis

Physiotherapy is an essential part of the treatment

At least six months of physiotherapy is recommended.

Therabite device

Gap and interpositional arthroplasty using the temporalis muscle flap effectively manage TMJ ankylosis

Braimah et al. (2018)/ [19]

Retrospective study

36

13.8 ± 6.6

To evaluate the TMJ ankylosis management approach

Trauma due to a fall

Bony and fibrous ankylosis

Effective therapy requires intensive postoperative physiotherapy for six months. Preventing re-ankylosis requires jaw physiotherapy

Active physiotherapy is essential for managing TMJ ankylosis

Dowgierd et al. (2022)/ [20]

Single-center prospective cohort study

33

14.24 ± 3.23

To outline TMJ ankylosis treatment

Inflammatory, trauma, and congenital or iatrogenic

Early intervention approach for temporomandibular ankylosis in children and adolescents using 3D virtual surgical planning and customized biomaterials

Before temporomandibular prosthesis insertion, intensive physiotherapy improves mandible function

Gap arthroplasty and thorough therapy before temporomandibular prosthesis outweighed costochondral autografts

Elgazzar et al. (2010)/ [35]

Clinical retrospective study

101

19.43

To explore the experience of managing TMJ ankylosis and compare the outcomes of different protocols

Trauma, previous TMJ surgery, osteoarthritis, hyperplasia, and infection

Bony, fibrous, and ankylosis

- Physiotherapy was a vital part of the treatment

- Patients were encouraged to continue mouth-opening exercises at home.

 massage, and deep heat therapy

Timely TMJ ankylosis release, bone grafting during ramus height reconstruction, and vigorous physiotherapy are efficient management approaches for TMJ ankylosis

Erol et al. (2006)/ [36]

Clinical study

59

18 ± 6.4

To explore the experience of managing TMJ ankylosis

Otitis media, Rheumatoid Arthritis, landslide, traffic accident, birth forceps trauma, and falls

Bony and fibrous ankylosis

Physiotherapy helps avoid postoperative adhesions and re-ankylosis.—Start post-op exercises and physiotherapy immediately

- Falls were the most common cause of ankylosis.—Early postoperative exercises and physiotherapy are essential

Fariña et al. (2018)/ [37]

Clinical study

15

11.4

To establish a treatment approach for TMJ ankylosis emphasizing functional and morphological efficacy

Unspecified

TMJ ankylosis leads to functional and morphological deficits and stunted craniofacial development

- Physiotherapy is fundamental for the stability of treatment results.—It consists of specific exercises performed multiple times a day

The proposed algorithm is functionally and morphologically efficient in managing TMJ ankylosis

Güven O (2000)/ [38]

A clinical and retrospective study

42

Unspecified

To explore the historical background of TMJ ankylosis management

Trauma and Infection

Unilateral ankylosis: mandible hypoplasia, chin deviation on the affected side

Bilateral ankylosis: severe retrognathia, mandibular alveolar protrusion, open-bite deformity, bird-face look, hypertrophic and thick coronoid process, night snoring, OSA

- Physiotherapy was used as part of the treatment protocol.—Physiotherapy was reported to be painful

Mouth opening and closing exercises using wooden gags and an inter-insical acrylic gag with a jack screw

The spherical acrylic spacer offers a shorter operating time and is economical

Hegab A. F (2015)/ [39]

A Prospective Clinical Study

14

18.5 median age (12—38)

To investigate the efficacy of ankylosis management using pathogenesis

Trauma and falls

- Patients with TMJ ankylosis

- Preoperative assessments included patient history, clinical and radiologic examinations

- Wooden tongue blades used

- Immediate, continuous aggressive physiotherapy for six months.—Physiotherapy helps prevent adhesions and redevelop muscle function

The treatment protocol is efficient in managing TMJ ankylosis and preventing re-ankylosis

Jain et al. (2008)/ [21]

Retrospective study

44

13.814

To explore TMJ ankylosis management protocols

Falls from heights can cause chin trauma and otitis media

Bony and fibrous ankylosis

Ferguson's mouth gag and wooden

Tongue blades

Physiotherapy after surgery is essential for long-term maintenance.—Postoperative intense jaw physiotherapy for six months

Timely TMJ ankylosis management is critical. In addition, aggressive physiotherapy is essential for long-term postoperative outcomes

Jakhar et al. (2013)/ [40]

Clinical study

90

14

To investigate the significance of condyle and disc retention in ankylosis management

Trauma

- Severely limited mouth opening with mandibular deviation

- No palpable condylar movements or joint pain

- Lack of postoperative physiotherapy led to recurrence in 3 patients.—Intensive physiotherapy program started on the third day postoperatively

The condyle and disc preservation effectively manage TMJ ankylosis with various advantages

Kaban et al. (1990)/ [22]

Retrospective study

14

18.33 ± 12.56

To investigate the efficacy of a TMJ ankylosis management protocol

Trauma, ankylosing spondylitis, and osteochondroma

Fibro-osseous ankylosis, fibrous ankylosis, and bony ankylosis

Aggressive physiotherapy is necessary to eliminate adhesions and avoid soft-tissue constriction. The physiotherapy regimen includes heat, massage, ultrasonography, gum chewing, manual stretching, and the Bell Dynamic Jaw Exerciser

The treatment protocol is effective in managing TMJ ankylosis

Khalifa G. A (2018)/ [41]

Prospective observational clinical study

26

16.27 ± 1.48

To assess mouth-opening changes after gap arthroplasty

Unilateral condylar fracture, Bilateral condylar fracture, and Chin trauma

Type I, II, III, and IV

Mouth gags, mouth prop, and chewing gum

Maximum interincisal opening assessment is critical for the timely detection of re-ankylosis

Kohli et al. (2017)/ [23]

A Prospective Comparative Study

22

24.5

To compare condylar reconstruction approaches regarding function and morphology

Unspecified

- Similar mean mouth opening in both groups

Jaw exercises with mouth gag

Sternoclavicular grafts treat TMJ ankylosis better than transport distraction osteogenesis

Lo et al. (2008)/ [42]

Clinical study

19

29.12

To develop and clinically test a TMJ exerciser

Trauma, mandibular, Orthognathic surgery for cleft deformity, and facial fracture

- TMJ hypomobility and trismus

- Patients with various causes of TMJ dysfunction

- The new exerciser is a satisfactory device for physiotherapy of TMJ hypomobility and trismus

Power screw technique

The maximal incisor opening increased significantly after using the device

Longobardi et al. (2009)/ [24]

Observational Cohort Study

18

31.3

To assess the efficacy of a three-phase treatment protocol for managing TMJ ankylosis

Previous condylar fractures, Caustic burn, Postsurgical scar, Pyogenic infection, Pseudocamptodactylia, and Trauma with loss of substance

- Limitations in oral opening due to ankylosis

Bite block

- Physiotherapy is a phase of the treatment protocol

- Physiotherapy is challenging to undertake immediately after surgery

The 3-phase treatment protocol is efficient for managing TMJ ankylosis

Nitzan et al. (2012)/ [25]

Retrospective Case Series

13

20

To explore an alternative treatment approach to TMJ ankylosis using computed tomography

Trauma

Condylar fracture

- Treatment includes intensive supervised physiotherapy

The condyle and disc head displacement are efficiently searched using computed tomography

Only ankylotic material is accurately removed, retaining the condyle-disc apparatus

Nouman and Hassan (2017)/ [43]

Experimental study

15

Unspecified

To evaluate the efficacy of physiotherapy following TMJ ankylosis surgery

Unspecified

- TMJ ankylosis interferes with chewing, speech, and oral hygiene

- It can cause gross facial deformities if not treated

Facial exercises, electrical stimulation, and using an ice cream stick

- Mouth opening exercises and electrical stimulation were used

- Facial exercises and home exercise programs implemented

Physiotherapy and mouth-opening exercises are essential in managing TMJ ankylosis

Park et al. (2019)/ [44]

Clinical study

9

35.4

To assess the effectiveness of interocclusal splint for physiotherapy in managing TMJ ankylosis

Trauma and infection

Fibrous, bony ankylosis, Chronic osteomyelitis, pseudo ankylosis, and stylohyoid ligament calcification

Interocclusal splint

- Physiotherapy helps prevent adhesion and re-ankylosis

Ankylosed mass resection and physiotherapy are essential in managing TMJ ankylosis

Rahman et al. (2020)/ [45]

Clinical and Radiological Study

15

12.6

To evaluate the suitability of dermal fat for reducing pain during active physiotherapy

Fall from height and infection of the ear

Osseous or fibro-osseous ankylosis

Early, intensive postoperative physiotherapy is crucial

The dermis fat graft could be a superior choice in managing TMJ ankylosis

Sahoo et al. (2012)/ [46]

Clinical study

64

14.3

To compare the outcomes of alternative approaches for managing TMJ ankylosis

Trauma, infection, and systemic illness

Limitations in mouth opening, dentofacial deformities, malocclusion, poor oral hygiene, dental caries, aesthetic impairment, malnutrition, and OSA

Ice cream blades

- Non-compliance to postsurgical physiotherapy led to re-ankylosis

- Active physiotherapy was carried out postoperatively for six months

Interpositional arthroplasty with temporalis myofascial flap is effective for mild mandibular deformities

Sami et al. (2023)/ [26]

Prospective study

12

11.2

To compare the outcomes of using temporalis fascia as an interpositional graft

Fall from height and ear infections

Unspecified

Early, intensive postoperative physiotherapy is crucial

Physiotherapy prevents and treats TMJ hypomobility and ankyloses

Cutaneous fat grafts and temporal fascia are effective when treating TMJ ankylosis

Shetty et al. (2019)/ [27]

Retrospective study

98

20

To evaluate the outcomes of a two-phase physiotherapy approach after consecutive ankylotic mass resection

Unspecified

Problems with mastication, talking, and mouth opening (re-ankylosis) are common

- A novel physiotherapy procedure involving two stages was demonstrated

- The success of the physiotherapy treatment relies heavily on patient acceptance

The longevity and rigidity of interpositional graft insignificantly influence the outcomes of TMJ ankylosis management

Shivakotee et al. (2020)/ [28]

Case series

18

17.66

To measure the effectiveness of treatments for TMJ ankylosis

Trauma and Congenital

- Mastication, digestion, speech, and hygiene can all be affected by TMJ ankylosis

- Common among young children

- Physiotherapy is emphasized for all patients

Interpositional arthroplasty with vascularized temporalis fascia flap can avoid re-ankylosis

Singh et al. (2014)/ [29]

Retrospective study

15

12.2

To assess lateral arthroplasty for TMJ ankylosis

Trauma

- Trauma was the etiological factor in all cases

Mouth prop, mouth gag, and spoon spatulas

- Postoperative physiotherapy began on day one

The therapy comprised active and passive exercises

Type III ankylosis patients benefit from the medially displaced condyle and disc

Singh et al. (2012)/ [30]

Prospective study

10

17.7

To assess the suitability of sternoclavicular graft as an interposition graft in managing TMJ ankylosis

Trauma and infection

- 10 patients with TMJ ankylosis, aged 12–35 years

- Complete osseous ankylosis, mean duration 6.4 years

Mouth prop, mouth gag, and spoon spatulas

- The physiotherapy treatment comprised active hinge-opening and excursive movements

Sternoclavicular Graft, Buccal Fat Pad Lining interposition, and active physiotherapy are essential for managing TMJ ankylosis

Tauro and Manay (2020)/ [31]

Observational cohort study

21

19

To propose modifications to the surgical approaches in managing and minimizing re-ankylosis

Unspecified

21 patients with TMJ ankylosis

- Aggressive intermittent intraoperative jaw physiotherapy

- Rigorous postoperative jaw physiotherapy

The proposed approach effectively minimizes re-ankylosis

Lin et al. (2019)/ [32]

Retrospective study

32

Unspecified

To explore the outcomes of retaining the medially displaced residual condyle in managing TMJ ankylosis

Accidental impact, violence, and accidental fall

- Limited ability to open mouth, difficulties with eating and speech

- Physiotherapy involves active and passive mandibular movement and maximal mouth-opening exercises

The displaced condyle should be preserved in managing TMJ ankylosis

Yadav et al. (2021)/ [33]

Retrospective study

114

15.75 ± 9.76

To investigate a method for reducing re-ankylosis after TMJ ankylosis surgery

Trauma and infection

- 114 patients (n = 152 joints) evaluated retrospectively

- Interpositional arthroplasty, costochondral graft, and complete joint replacement were used

Tapered acrylic trismus screw

- Aggressive physiotherapy is vital to prevent re-ankylosis

The risk of re-ankylosis can be minimized by following the proposed treatment protocol

Younis et al. (2020)/ [47]

Prospective Clinical Comparative Study

30

6.5

To compare cutaneous fat graft and temporalis myofascial flap as interposition grafts for TMJ ankylosis

Trauma and otitis  media

- TMJ ankylosis causes difficulty in chewing, speech, and oral hygiene

Wooden spatulas

- Physiotherapy techniques were used in the study

Dermis fat grafts may be better than temporalis myofascial flaps for treating TMJ ankylosis

Zhang & He (2006)/ [48]

Retrospective study

18

28

To assess condylar fracture-related TMJ ankylosis and postoperative outcomes

Trauma

- Type I ankylosis develops in the 4th to 5th-month post-trauma with 183 ± 55 mm mean interincisal opening

Physiotherapy

Disc repositioning is effective for TMJ ankylosis management

- Close follow-up for 18 months after condylar fractures

- Surgical intervention for fibrous ankylosis after two months