In a first for the country, according to doctors at AIIMS, a 19-year-old boy underwent Temporomandibular Joint (TMJ) replacement surgery, where the fused bones of his skull and jaw were removed and replaced with an joint implant — a sort of miniature version of implants used in knee joint replacements.
After the surgery, completed in two sittings on October 1 and October 8, Shivam Sharma had his first plate of golgappas. It was the first time that the Class XII student from Hisar, Haryana, could open his mouth fully since the age of 10 when he fell from his terrace while flying a kite and fractured his jaw.
Like most of the 150-odd patients awaiting similar surgery at AIIMS, when Shivam had the accident, he treated all other fractures barring that in his jaw. Within weeks, he developed a condition called TMJ ankylosis or fusion of the lower jaw with the skull bone. Doctors said the condition is commonly seen in cases where jaw fractures are not immediately treated and the joint is not used for a sustained period.
“Sometimes children cannot identify a fracture. So they just stop using the joint for a while. Shivam’s parents were feeding him mashed food through the gaps between his teeth, because he could not chew or swallow. He could not even speak properly. His facial structure was asymmetric because of the fusion of the skull and jaw bones. He also had breathing difficulties,” Dr Ajoy Roychoudhury, HoD oral and maxillofacial surgery at AIIMS, said.
In Shivam’s case, the symptoms were worsened because the fusion was on both sides of his mouth. “It affected my studies. It was hard making friends because I looked different. I watched so many people eat golgappas and felt my mouth water,” Shivam said.
In 2012, doctors had tried to use a different surgery technique to fix Shivam’s jaw. But the procedure was unsuccessful.
The AIIMS surgery was performed with specialised anaesthesia, using fibroptic techniques, since Shivam could not open his mouth for the tube. Doctors said an X-ray before the surgery total fusion of bones. In the surgery, the neurovascular structure of joint, including the nerves and muscular structures were removed, and the FDA-approved imported implants were surgically put.
Shivam’s father Purushottam Sharma said each of the two implants cost Rs 1.5 lakh. However, Dr Roychoudhury said more investments and attention from the government was required to bring down the costs.
According the doctors, 400-450 such surgeries had been performed in Europe and the USA since 1995. But this was the first for India, they said. “This is surprising because the incidence of TMJ ankylosis is much higher in Asian countries, particularly India,” Dr Roychoudhuy said.
Doctors said the fusion may recur in adult patients after temporary surgical interventions are used to separate the fused bones. “For adult patients, total replacement of the joint with an artificial implant is considered the best treatment,” Dr Ongkila Bhutia, additional professor in the department, said.
Bhutia said unlike knee implants, which may have to be replaced frequently, TMJ implants may never have to be replaced as they are not used as much. “But since it is an implant there could be a need for replacement in 10-12 years,” she said.