# Post-surgical Hypertrophic Scar in a Patient With Unilateral Temporomandibular Joint Ankylosis

## TL;DR

This paper discusses a case of a patient who developed a large scar after surgery for a jaw joint condition and highlights the importance of a team approach to manage such scars.

## Contribution

The paper presents a specific clinical case of post-surgical hypertrophic scarring following TMJ gap arthroplasty and emphasizes the role of a multi-professional team in wound management.

## Key findings

- Post-surgical hypertrophic scarring can occur after TMJ gap arthroplasty through the Al-Kayat Bramley incision.
- A multi-professional team approach is essential for effective management of post-surgical scars in TMJ patients.

## Abstract

Wound healing is nature’s response to injury. It is a complex and dynamic process involving multiple biological systems aimed at restoring the integrity of damaged tissue. The temporomandibular joint (TMJ) is a critical anatomical structure that facilitates jaw movement and function. TMJ ankylosis is a pathological condition characterized by fusion of the mandibular condyle to the glenoid fossa resulting in severe restriction in mouth opening and significantly reduced mandibular movements. This condition affects the patient’s quality of life by deteriorating major functions such as mastication, speech, oral hygiene, breathing, facial growth, and esthetics. Gap arthroplasty is the mainstay of treatment. There are various surgical approaches to TMJ such as Al-Kayat Bramley, Popowich’s modification, Blair’s inverted hockey stick, Dingman’s, Thoma’s, endaural, postauricular, and rhytidectomy incisions. Wound healing in the TMJ region poses unique challenges due to its complex anatomy and the high level of mechanical stress it endures. Following trauma to TMJ, hematomas are organized by fibrous granulation tissues and mesenchymal stem cells are recruited from adjacent bone by cytokines and chemokines such as bone morphogenetic proteins, transforming growth factor-beta and stromal cell-derived factor 1. These recruited mesenchymal cells differentiate into osteoprogenitors and osteoblasts to form new bone and fibroblasts to form a scar. In humans, scarring is the final outcome of the wound healing process, which has evolved to rapidly repair injuries. Scarring from injuries, surgeries, and burns places a significant burden on the healthcare system. Patients with major scars, especially children and adolescents, often experience long-term functional and psychological issues. This article aims to present a case of post-surgical hypertrophic scar in a patient after gap arthroplasty through Al-Kayat Bramley incision and the role of a multi-professional team to treat such wounds.