Wednesday, October 7, 2026

TMJ Ankylosis in 17-Year-Old: Case Report

Introduction

Ankylosis is a Greek terminology meaning «stiff joint.» It can be defined as «inability to open mouth due to either a fibrous or bony union between the head of the condyle and glenoid fossa Ankylosis is a Greek terminology meaning “stiff joint”. It can be defined as “inability to open the mouth due to either a fibrous or bony union between the head of the condyle and the glenoid fossa [1]. TMJ ankylosis is a disorder that results in restricted mouth opening and inability to perform normal jaw functions or may sometimes lead to immobility of jaws. It may occur as a result of trauma (13- 100%), local or systemic infections (0-53%) or systemic diseases like psoriasis, ankylosing spondylitis, rheumatoid arthritis [2]. In ankylosis, the normal architecture of the joint is altered. It is a severe disability that results in restricted mouth opening, difficulty in mastication, speech, yawning, and nutrition. There may be associated restricted airway problems (obstructive sleep apnea– hypopnea syndrome). When this disease occurs in a growing child, it mostly affects the mandibular development, leading to complex and extensive dentofacial deformities with associated malocclusion [3,4]. Temporomandibular ankylosis is one of the most common pathologies encountered in children but it mostly remains undiagnosed and unmanaged resulting in social and psychological impacts on their lives.

Discussion

Ankylosis of temporomandibular joint (TMJ) is an intracapsular union of the disc-condyle complex to temporal artic-ular surface that restricts mandibular movement, including the fibrous adhesions or bony fusion between condyle, disc, glenoid fossa, and articular eminence [1]. Tmj ankylosis is “the pathological fusion between glenoid fossa of temporal bone and the condylar process of the mandible “. Ankylosis of the temporomandibular joint is an intracapsular union of disc-condyle complex to the temporal articular surface that restricts the functional capacity of the mandible which can be either fibrous adhesions or bony fusion between the condyle, disc , glenoid fossa and articular eminence. [5] This condition may lead to chronic, persistent, and progressive inability to open the jaw, facial deformity, and obstructive sleep apnea–hypopnea syndrome. [6] It affects the quality of life by interfering with mastication, speech, maintenance of oral hygiene and poor esthetics It affects the quality of life by interfering with mastication, speech, maintenance of oral hygiene and poor esthetics. TMJ ankylosis often occurs in young age and hampers the growth resulting in facial deformity and poor airway space. The etiological factors include trauma (most commonly), infection (otitis media, parotitis etc), previous TMJ surgery, and systemic illnesses like psoriasis, rheumatoid arthritis, etc [7]. Other etiological factors are: myositis ossificans, osteochondroma, ankylosing spondylitis (Bechterew Disease) psoriatic arthritis [8], systemic lupus erythematosus, radiotherapy or surgical treatment of TMJ [9].TMJ ankylosis has also been described as a complication after orthognathic surgery [10]. Ankylosis of the TMJ may be classified using a combination of the site (intraarticular or extraarticular), type of tissue involved (bony, fibrous, or fibro-osseous), and extent of fusion (complete or incomplete) [11]. Tripathy et al. have classified ankylosis as true or false. In true ankylosis there is bony or fibrous adhesion between the surfaces of the joint within the capsule, whereas in false ankylosis the problems lie in the surrounding structures [12].

El-Hakim and Metwalli Classification of TMJ Ankylosis

• Class I: Unilateral and bilateral fibrous ankylosis, where condyle and glenoid fossa retain their original shape, and maxillary artery lies in normal anatomical relation to the ankylosed mass

• Class II: Unilateral or bilateral bony fusion between the condyle and the temporal bone, but the maxillary artery lies in normal anatomical relation to the ankylosed mass

• Class III: Distance between maxillary artery and the medial pole of the mandibular condyle is less on the ankylosed than on normal side or the maxillary artery runs within the ankylotic bony mass (seen on coronal CT scan)

• Class IV: The ankylosed mass appears fused to the base of the skull with extensive bone formation, especially in the medial aspect of the condyle such that the ankylosed bony mass lies in close relationship to the vital structures at the base of the skull, such as pterygoid plates, carotid and jugular foramina, and foramen spinosum, and no joint anatomy can be defined from the radiograph (visualized on axial CT scan ) [13].

Radiographic assessment plays an important role in the diagnosis of Tmj ankylosis. CT scan remains to be the gold standard . Axial and coronal sections and three-dimensional reconstruction show the medial extent of ankylosis, which is not visible on conventional radiograph. Axial and coronal sections and three-dimensional reconstruction show the medial extent of ankylosis, which is not visible on the conventional radiographs. CT angiography can be a useful adjunct in the treatment of patients with TMJ ankylosis with a large mass or recurrence or a history of multiple previous TMJ surgeries to determine the relationship of the medial vasculature to the mass [14].

Management

Treatment of TMJ ankylosis is very challenging and rewarding. The aims of the treatment are to establish movement of the joint with adequate mouth opening, maintain a functional occlusion, reconstruct the joint using biological material, correct facial deformity, and to prevent recurrence. Treatment options are listed as follows: Gap arthroplasty with coronoidectomy [15], Lateral gap arthroplasty [16] Interpositional arthroplasty with Temporalis muscle and fascia (Kaban, et al. [17]), Dermal fat (Dimitroulis, et al. [18]), Buccal fat (Rattan, et al. [19]), Auricular cartilage (Lei, et al. [20]), Fascia lata (Narang, et al. [21]), Lyophilized cartilage (Raveh, et al. [22]), Dura (Schobel, et al. [23]), Full thickness skin (Chossegros, et al. [24]). In 2019 Rawaa Y. Al-Raweea, Ali Mohammad Saeed Al-Khayat b, Saud salim Saeed published a case report with similar treatment plan [25].

Case Report

Figure 1: Extra oral photograph.

A 17 year-old boy reported with the complaint of inability to the open mouth since 7 years. He gave a history of a trauma to his chin from height fall at age 10 years, and there was a Para symphyseal fracture for which he got operated on then. He eventually recognized the inability to open the mouth within 1-2 years after trauma. No medical or surgical intervention was done in the past. Extra oral examination revealed facial asymmetry with fullness of cheek on the right, ramus height and mandibular body was small, with increased gonial angle. His feeding was characterized by an inability to masticate food, limiting intake to liquids or semisolids. He had a convex profile , severely retrognathic mandible , absence of chin button and bimaxillary protrusion . Figure 1 Intra oral examination revealed null mouth opening. Upper and lower teeth were misaligned and proclaimed due to lack of apical basal bone Figure 2. Radiographic examinations comprised of the orthopantomogram Figure 3 and computerized tomography Figure 4 that revealed a lack of structural organization and the obliteration of right TMJ space. Based on these findings, a diagnosis of unilateral left bony TMJ ankylosis was confirmed. He was also suffering from social and psychological disturbances with low self-confidence.

Figure 2: Intra oral photograph.

Figure 3: Orthopantamogram.

Figure 4: Bramley Al Kayat incision.

Treatment

A sequential protocol for the treatment of TMJ ankylosis is based on aggressive resection of ankylotic mass. While respecting, a special approach has to be directed particularly to the medial aspect of the joint which is in close proximity to the internal maxillary artery to ensure that the bony, fibrous, and granulation tissues are completely removed. After complete evaluation, a surgical treatment with interpositional gap arthroplasty on the left TMJ using Kaban’s protocol was planned under general anesthesia. The surgical approach consisted of alkayat and bramley preauricular incision. Figure 5 Full thickness mucoperiosteal flap was reflected Figure 6 and the ankylotic mass was exposed. Figure 7 The section consisted of two horizontal osteotomy cuts which were placed at the level of the joint (below the zygomatic arch) and removal of a bony wedge was done so that a gap were created between the roof of the glenoid fossa and the ramus. It is not possible to remove the entire block in toto; hence, the bone was removed carefully by using surgical burs until the bone is thinned which was then removed using a chisel or osteotome. Next step was to perform cricoidectomy on the same side The joint cavity was then irrigated with normal saline, and the bony margins were smoothed using bone file.

Figure 5: Mucoperiosteal flap raised.

Figure 6: Ankylotic mass exposed.

Figure 7: Mouth opening using mouth gag.

Aggressive early mobilization of the jaw by creating a Forceful mouth opening of about 45 mm using the mouth gags at the time of surgery. Figure 8 Temporalis fascia flap harvested from the same surgical site and rotated over the zygomatic arch to cover the whole of the glenoid fossa and sutured anteriorly, laterally, and posteriorly. Figure 9 Suction drain was placed, and the flap was sutured using 3-0 vicryl for deeper layers and the skin was closed using staple sutures. The width of the bone removal is considered crucial. It is recommended to create a gap of at least 1 cm to prevent ankylosis. It is also important to create a gap of equal dimension both laterally and medially, so that the possibility of ankylosis due to bone contact is avoided. Post-operative Course: The postoperative course was uneventful. A mouth opening of 30 mm was noted 2 days after surgery. Vigorous postoperative physiotherapy was started to maintain the mobility of the joint. After 7 days with physiotherapy using a wooden spatula, the mouth opening was noted to be 30mm. Later,mouth opening exercises were started. His mouth opening improved to 35mm after 6 months. Figure 9 The patient is on regular monthly followup and he is instructed to continue with the exercises for at least a period of 1 year

Figure 8: Temporalis fascia harvested.

Figure 9: Post-operative 6 months.

Conclusion

As a result of Tmj ankylosis patient’s mouth opening is restricted which carries a mental stigma that overweighs the physical disability posed by the problem. Such patients are psychologically handicapped and hence call for a unique approach to their rehabilitation. A detailed history, clinical and functional examination, radiographic examination facilitating correct diagnosis followed by immediate effective surgical intervention, and physiotherapy can help us to restore the physical, psychological, and emotional health of the Tmj ankylosis patient.

BJSTRAngelaRoy

Tuesday, October 6, 2026

Lymphatic Filariasis in a Migrant Patient with HIV Infection

Case Report

In December 2020, a Nigerian patient (EDO state), went to our Emergency room in Grand Metropolitan Hospital of Reggio Calabria. He was 38 years old, he lived in Italy for 3 years and was looked after by another Infectious Unit because of HIV infection. He was in our emergency room because of asthenia and a pain in his left lower limb. The patient’s vital signs were within normal limits, his blood tests showed: normochromic normocytic anaemia (Hb 7.6 g/dl), white blood cells within limits (WBC 5500mmc), marked eosinophilia, (EO 28,5%, absolute count 1570mmc), thrombocytopenia (PLT 53.000mmc), kidney and liver functions within normal limits. After a consultation with an infectious disease specialist the patient was hospitalized in the Infectious Disease ward. Physical examination of the chest and abdomen was normal, while he presented picture of elephantiasis of the left lower limb. During his hospitalization, with prior consent, the patient received blood transfusions. He underwent chest x-ray and abdomen ultrasound, both normal.

The patient presented with a moderate viro-immunological compensation (he tooked elvitegravir/cobicistat/emtricitabine/ tenofovir disoproxil), with undetectable HIV-RNA levels and CD4 640mmc. Serology for HBV and HCV, lue and leishmania were all negative; quantiferon test negative too. Serology for toxoplasma and CMV showed previous infection. As for the marked eosinophilia, the patient was subjected to urine and stools parasitological examination on three samples with negative output. Considering the laboratory data of marked eosinophilia and the clinical picture of elephantiasis of the left lower limb, we send a blood sample for endoscopy. The endoscopy revealed Wuchereria Bancrofti microfilarial presence which allowed us to diagnose a lymphatic filiarasis case. Considering microbiological data, the hospital pharmacy was required to supply ivermectin and albendazole, however, only a few hours after the microbiological diagnosis, the patient withdraws consent to the treatment and, against the advice of the health professionals, resigns himself.

Discussion

Lymphatic filariasis (LF) is a neglected tropical disease according to the World Health Organization [1]. It is transmitted through different types of mosquitoes and it was estimated that in 2018, 51 million people would be affected [1]. LF is caused by parasites classified as nematodes and Wuchereria bancrofti is responsible for the 90% of the cases of filariasis.

Figure 1: Microfilaria Wuchereria Bancrofti seen on thick blood smear, stained with Giemsa and focused under oil immersion (100x) magnification.

The typical lymphatic filariasis clinical pictures is characterized by lymphoedema and hydrocele [1]. Our report refers to a migrant from Nigeria, a country considered endemic by WHO [2]. Our patient showed typical filariasis symptoms, revealing left lower limb lymphoedema with elephantiasis. Furthermore , from the laboratory point of view this patient showed a marked eosinophilia typical of tissues invasive parasitosis such as lymphatic filariasis [3]. The microbiological diagnose showed the presence of Wuchereria bancrofti microfilariar on a blood sample; however, it is also possible to diagnose LF by serological and molecular methods [4]. From the point of view of HIV-filariasis coinfection, while a significant difference in the prevalence of filariasis disease between HIV positive and HIV negative is not demonstrated in endemic countries [5], on the other hand, a significant increase in the risk of acquiring HIV has been shown for individuals with heartworm infection [6]. Of great importance is the problem of access to anthelmintic therapy. Due to migratory flows, in Europe there is an increase in cases of NTD and at the same time the difficulty in finding drugs [7],in fact, in accordance with the guidelines of the Italian Society of Tropical Medicine, we would have treated, if the patient had not decided to withdraw consent to the treatment, filariasis according to the ivermectin + albendazole scheme [8], and not with diethylcarbamazine due to difficulty in finding this’ last (Figure 1).

Conclusion

In conclusion, the possibility of lymphatic filariasis, or other NTD, should always be considered in patients from endemic areas, however, especially in Europe, there is difficulty in accessing treatment. Further studies are needed to better characterize Wuchereria bancrofti infection in the patient with HIV disease.

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Thursday, October 1, 2026

The Effect of Interface Design and Perceived Risk of Customers’ Satisfaction and Loyalty on Online Booking Application

Introduction

The rapid development of Internet has increased people’s preferences to use internet to manage their needs such as using online booking applications for traveling and lodging. A number of online booking applications have been established to provide information and to make people to feel convenience when manage their travel plans. Various online travel booking services also compete each other to get orders and to increase customer satisfaction through increasing their service quality. Previous research has shown the factors that influencing consumers’ intention to re-visit the website and re-purchased by online. Of many factors that have been evaluated by scholars, web design or interface design [1-3] and perceived risk [4-6] are the factors influencing the decision of consumers to browse and to make e-purchase deals from particular websites or applications including on online travel booking application. Interface is the part of computer system that allows users or browsers can interact [7]. Through combination of hardware and computer software, interface connects users to meet their needs. The interaction between human and computer system is different in most of the websites depending on the design of the interfaces. As an example, each website provides the different kind of buttons, symbols, pictures, and touch pads to be clicked in the screen to show the next process or steps. Several criteria that important to be considered when design computer system including website page is easy to use, easy to learn, reduce harm, easy to get help, easy to check, easy to share in groups, and easy to integrate into existing systems [8]. The website programmers should design the appearance of the website and its interface to be interesting to attract the visitors and to satisfy them when searching of what they need. For online marketing, the interface design is a basic step of trading process because it is a media and tool to communicate with consumers both to offer and to make transaction. Hence, the good quality design of interface can attract consumers to purchase from the online vendors. Another factor that influence people to decide to make e-purchases is the availability of risk or perceived risk. Perceived risk is often associated with trust because these terms are related each other. Perceived risk in shopping can be defined as the possibility of loss [9].

Consumers perceive risks because they face uncertainty and adverse consequences on undesirable result of product or services purchases [10]. Considering the shopping method, online shopping is more risky compare to face to face interaction [11] because in online shopping, consumers cannot clearly see the goods like in the physical stores. The researches that studied the correlation of web design with e-purchase or online purchase have been done by scholar but the research relating interface design are still limited. The researches on the correlation of perceived risk with online shopping also have been conducted in previous studies. However, the researches that combined the interface design and perceived risk online purchase and correlated them to demographic background are still limited. Additionally, the specific topic of the studies on the service purchase particularly in hospitality and travel reservation are still not much assessed. Hence, this study intended to examine correlation of the online booking interface design and perceived risk toward consumers’ satisfaction and loyalty. This study purpose also was to examine correlation of demographic background with the perception on interface design, perceived risk, and loyalty on online booking.

Research methods

Sampling and Data Collection

The respondents in this research were Taiwanese consumers who ever used online booking application by Internet. They are who have credit or debit card used to process online transactions. The data collection was conducted by online survey through sending questionnaires by Facebook and Line applications. The data collection was carried out from December 1, 2019 to January 31, 2020. The number of samples was 387 samples. The respondents were categorized based on gender (F= 197; M=190), educational level (junior-senior high school=36; bachelor=235; master or above/research work=116), and age (< 30 years old=49; 30-39 years old= 159, 40-49 years old=125; 50-59 years old=54).

Research Hypotheses

The purpose of this research was to understand the relationship between interface design, perceived risk, customer satisfaction, and customer loyalty on online booking reservation. A previous research conducted by (Ludin et al. [1,2]) studying web design and customer satisfaction mentioned that the information quality and system quality of the portal or website the most important way to obtain customer satisfaction. It is because the quality of the interface affects consumer acceptance, which means that if the information provided in the interface good, the satisfaction of the consumers also good. The complete and interesting appearance (buttons, colors, images, formats, charts, and etc.) and the easiness to use of interface will increase customer satisfaction [12-14]. Hence, from these findings, we developed the hypothesis, i.e. hypothesis 1: There is a positive correlation between interface design of online reservation applications and consumers’ satisfaction. Although e-commerce shopping system provides a number of benefits to customers, online shopping and online transaction also have risks. (Crespo et al. [4]) argued that perceived risk can decrease the consumption behavior. (Mattila [15]) pointed out the relationship between the perceived risk of business travels and consumption behavior after purchasing is contradictory, which mean that perceived risk level has negative impact on the level of customers’ satisfaction. For online booking, (Swaminathan, et al. [16]) stated that if the transaction is not safe, the perceived risk will increase and the importance of online transactions will also decrease. Hence, from those statements, the following hypothesis developed in this study was: hypothesis 2: there is a negative correlation between consumers’ perceived risks on online reservation and consumers’ satisfaction. According to the research of customer satisfaction and loyalty, (Anderson, et al. [17]) found that customer loyalty (purchase) is closely related to product intention. (Reichheld, et al.[18]) pointed out that customer satisfaction can lead to increase customer loyalty, and satisfaction will increase their consumption. (Elkhani [19]) conducting a research on ticket reservations found that overall customer satisfaction has a significant positive impact on loyalty. Therefore, the last hypothesis of this study was: hypothesis 3: there is a positive correlation between consumers’ satisfaction and consumers’ satisfaction on online reservation.

Data Analysis

The questionnaire consisted of a number of question items that related to the interface design (17 questions), perceived risk on online booking applications (11 questions), consumers’ satisfaction (10 questions), and consumers’ loyalty (7 questions) as they are provided in Table 1. The answers provided for each question and statement consisted of five level scales, starting from lowest level until to the highest level. As an example, for question A (1) “Interface layout makes the application easily to be operated” and the provided answer was

(1) Unimportant;

(2) Rather important;

(3) Neutral;

(4) Important; and

(5) Very important.

At the end of the questions of four variables, the respondents were asked about their opinion to confirm the importance of design interface, the availability of perceived risk, the satisfaction on the overall online booking application, and their loyalty on online booking application. For this type of question, the available answers were binomial, i.e: yes (1) or no (2). This research used quantitative approach, and all the answers were quantified the respondents’ answer with 5-level Likerts’ scale. The data were later used to examine the hypotheses. The analysis applied to evaluate the correlation of each variable was Pearson’s correlation. For this analysis, the data gained from the lists of questions with 5-level Likerts’ scale answer were used to examine the correlations (hypotheses). While to evaluate the significance of different demographic backgrounds toward four observed variables, this study used cross tabulation and Chi-square analysis. For this purpose, the yes/no questions provided in the end of each variable in the questionnaire were used to evaluate the significance. This study used the SPSS 25.0 version software as a tool to analysis the data (Figure 1).

Figure 1: The first research framework.

Results and Discussion

Result

Calculation of Cronbach’s alpha values was conducted to assess the reliability or consistency of the data. Theoretically, the result of Cronbach’s alpha should give a number from 0 to 1, but it also can be negative numbers. If the Cronbach’s Alpha value between 0.50 and 0.70, the data have the standard reliability, and if the Cronbach’s Alpha value between 0.70 and 0.90, the data have a high reliability. If the Cronbach’s Alpha value is higher than 0.90, it is a very high reliability. For this present study, reliability test result is provided in (Table 1). The reliability test shows that the Cronbach’s Alpha values are 0.887 for interface design variable and 0.897 for perceived risk, which mean that the reliability of the data of each variable is high. While for costumers’ satisfaction and loyalty, the Cronbach’s Alpha values are very high, which they are 0.945 for satisfaction and 0.943 loyalty, respectively. From this result, the further analysis can be continued because the existence and quality of the data are reliable.

Table 1: Goodness of fit and reliability test of criteria of each variable.

Correlation Analysis Of Inference Design, Perceived Risk, Customers’ Satisfaction, And Customer Loyalty: Correlation of each variable was examined with Pearson’s analysis, and the result is presented in (Table 2). Table 2 explains the significant and positive correlation between interface design and customer satisfaction (H1 is accepted). It means that when the quality of interface design increase, the level of satisfaction is also will increase. The correlation coefficient is 0.556 which mean that the correlation is strong according to the interpretation of r value (coefficient correlation value). Interpretation of r value is if r value exactly 1 (+ or -), it is a perfect linier relationship; if below 1 until 0.70 (+, -) is a very strong relationship; if below 0.70 until 0.50 is a strong relationship; 0.5 is moderate relationship, below 0.5 until 0.3 is a weak relationship; below 0.3 a very weak relationship; and 0 is there is no relationship (Rumsey, et al. [20]). Second, Table 2 also shows the significant correlation between perceived risk and consumers satisfaction with the direction is a negative line (H2 is accepted). It means that if the perceived risk of online booking application increasing, the satisfaction on the online booking application is decreasing. The correlation coefficient is – 0.204, which indicates that it is very weak correlation. Lastly, the correlation of customers’ satisfaction and customers’ loyalty shows a significant and positive correlation (H3 accepted). It means that when the satisfaction on online booking application is increasing, the loyalty of the consumers to keep using the applications is also increasing. The correlation coefficient is 0.640 which shows a strong relationship of the two variables. From these findings, it can be seen that the strongest correlation among the others is the correlation of costumers’ satisfaction between loyalty. It can be interpreted that when customers are satisfied with the particular online booking application, it definitely increases the loyalty of customers to use the particular reserve application in the next booking and to prioritize that application to when making travel plans.

Table 2: Pearson’s Correlation analysis of each variable.

Note: N = 387, ** is significant at 0.01 level, and * is significant at 0.05.

Table 3: Cross tabulation and Chi-square analysis on tested variables with respondents’ demographic background.

Note: * significant at 0.05 level; the filled boxes show the highest percentage of categories of significant observed demographic variables.

Correlation of Demographic of Respondents on the Observed Variables: To examine the significance of respondents’ background on the observed variables, the cross tabulation of the frequency of the answer were carried out, and the differences were evaluated using Chi-square test as presented in (Table 3). The result in Table 3 shows that the different level of education resulted in the significant result on the importance of interface design of online booking applications. For this variable, percentage of respondents who have master degree and higher level have the highest percentage compare to others. It means that the higher educational level, the more important of interface design when doing searching hotels or travel plans. For the crosstabulation of gender and level of age, they do not show a significant different on the importance of interface design. Relating the opinion on the risk of online booking, all the variables show the significant result. Female respondent valuing the risks of online booking is higher compare to the male respondent.

The percentage of master degree or above respondents valuing the risks of online booking is the highest among the other educational levels. Lastly, the oldest respondents (50-59 years old) believes that online booking reservation more risky compare to the younger respondents. For satisfaction in using online booking applications, all of the tested demographic characteristics show the significant result. The male respondents were more satisfied when doing online booking compared to the female respondents. The respondents who have the lowest educational level (junior-senior high school) were more satisfied compares to other educational level. Lastly, the customers in the youngest age level (below 30) were more satisfied compared to the other levels of age. Relating the consumers loyalty to use the online booking applications in the present and future, all of the tested basic characteristics show the not significant result. It means that the respondents have the same opinion that online booking application still the best choice when making reservation. It can be seen from the result, of 387 respondents only 10 of them who did not want to use internet to make reservation.

Discussion

Consumers’ satisfaction and loyalty are two important things that should be noticed by hospitality industry and travel business in marketing strategy. The vast using of internet have made the online marketing of lodging services is the best choice to promote the lodging services because there is no time and space limitation to potential customers to get the information and to make reservation by accessing the travel and lodging service information by online. Hence, the factors such as interface design and perceived risk that considered as an important. The aim of this study was to examine the correlation of interface design of online booking application, perceived risk of online transactions, customers satisfaction, and customers loyalty on online booking application. This study provides several findings. First, there is a significant and positive relationship between interface design and satisfaction on online booking application, particularly for making room reservation. It can be interpreted that if the quality of interface design is good or high and easy to be operated, the consumers will be more satisfied. Interface of application or website is the displays of particular apps of website that provides information that need to be conveyed to potential customers. Interface contains information including combination of texts, pictures, symbols, charts, and videos that is designed to deliver enough information to customers and that has purpose to attract consumers to use their service [12-14]. A result study from (Dholakia, et al. [21]) also added that the easiness to find the product and clarity of product information as the attributes in the interface of website vendors or online applications significantly influence customers’ satisfaction. The result of this study is in line with the previous studies which related to e-purchasing both online booking website and online shopping which found the positive correlation between interface and satisfaction [22,2].

Their study explained that the quality of interface or quality of website will increase the acceptance and satisfaction on e-commerce (Table 4). Perceived risk significantly decreases the satisfaction and loyalty to use the online booking application. This finding is consistent with the previous studies which mentioned that perceived decrease consumers’ attitude and intention to use the online application including for travel reservation [15,6]. The security risks perceived as the main and common causing factors of the consumers’ reluctance to use online booking applications [23,24,6]. The consumers percei ved that the process of finding the finest hotels and making financial transaction the system is not fully secure in their system or it can be hacked. The doubt of leakage of personal information, credit card information, and money loss after doing online booking and online transaction have affected the consumers decision to make online reservation. Another reason is the psychology factor that can be affected by the mismatch of what is offered with the reality. The information on products and services is usually gained by searching websites that provide type of the room, room pictures, and facilities. However, the clients cannot see the real condition of the room and the hotel comprehensively. Moreover, the hotels could not update the recent pictures of the room, they can make a trick on shooting angel to produce the better images of rooms that create optical illusion to clients, or even they do not provide the true information about their facilities to attract the consumers. These risks and the own previous experiences or other experiences decrease the consumers satisfaction and loyalty on online reservation.

Table 4: Cross tabulation and Chi-square analysis on tested variables with respondents’ demographic background.

Note: * significant at 0.05 level; the filled boxes show the highest percentage of categories of significant observed demographic variables.

Related the correlation of satisfaction and loyalty, this study found the strongest correlation between satisfaction and loyalty compared to other observed-paired variables. Which mean that if satisfaction increases, the loyalty definitely increases. Loyalty on online purchase or commonly said as e-loyalty is specified as the intention to re-visit the website and re-purchase from online vendors [25]. In this study, loyalty also include the consumers’ willingness to recommend the online booking applications to others and make online e-purchase as the main priority when making travel planning (to reserve lodging). To explain this finding, the consumer satisfaction diagram service developed by (Fornell, et al. [26]) describes that loyalty is positively influenced by satisfaction, and satisfaction is positively influenced by perceived value and quality. The respondents in this present study also mostly satisfy with the online hotel/travel preservation in previous experiences. Even though consumers perceived some risk when making online purchase, consumers presume that online booking still the best choice compare to traditional method because of its number of benefits such as lot of options, more convenience, more saving time, not limited by time and locations, global distribution, and many other benefits. Hence, the respondents were mostly agreed (97, 42%) to make e-purchase in future (the result in Table 3). This result which found the significant positive correlation between satisfaction and loyalty on online booking hotel are also supported by the previous researches that related to online purchase [27,21,1]. Differences on demographics of respondents also resulted in the different perception in some variables on the importance of interface design, perceived risk and satisfaction on online booking application. Female respondents perceived the higher risk of making reservation through online compare to male respondents, while related satisfaction male respondents more satisfy compare to female respondents. According to social psychology, men portray a set of personal traits related to adventurousness and a greater proneness to risk, whereas females are more in favor of easy and routine tasks [28].

The process of online boking and transaction with its high risk have made the female respondents perceived the higher risk of online process and more dissatisfaction on the process and the result made by online transaction compared to male respondents. Meanwhile, men with their own experiences with internet and technology have more be able to cope the online process risk and easier to choose and to adjust their needs by using the user interfaces which increases their satisfaction. Therefore, the alternative that the women can take is to use travel agency service to manage their needs. Furthermore, the different level of education shows the different result on the importance of interface design, perceived risk, and satisfaction with the result: the importance of interface design is perceived more important to the higher educational level; perceived risk is higher for the more educated people; and satisfaction is higher for the lower educated people. This finding indicates that education improves the ability to understand the internet and computer system that make the higher educated people perceive the more importance of the quality of web design and user interface to convey the information to users, and they also easily recognize the risk of online booking trough their experiences. However, relating to satisfaction, the lower educational level resulted in that the more satisfaction. Regarding age level, the oldest respondents perceived that the risk of online booking reservation is highest compared to other age levels. A study conducted by (Mayr, et al. [24,29]) found that the older customers (above 50 years old) less prefer to do online booking than the younger customers due to some reasons including the risk on online reservation and hardly to find the appropriate products, and they were the more dissatisfied customers.

Conclusion

The primary purpose of the study of correlation of interface design, perceived risk, satisfaction and loyalty is to find out the significant influencing factors on technology and social behavior and that lead to build the long-lasting relationship of consumers in e-commerce context. As we know that most of the people activities nowadays have used internet as the main tool, channel, or infrastructure to fulfill people needs. Hence developing a credible online application is important in marketing strategies including hospitality and travel business. This present study found that the increasing of quality of interface design of website increases the consumers satisfaction and loyalty to the hotel/travel online booking application. Which mean that the good design, enough and complete information, and easiness to be operated or to search the information of the products or services are important to be noticed by marketers in the website. Furthermore, the perceived risk will decrease satisfaction to make online purchase for lodging or travel reservation. The leakage of personal data and banking information is the main concern that influence the people intention to make online booking. Additionally, the incompatibility of feature and information in website with the reality is also an important aspect that decrease the people trust in e-purchasing. Hence, the service providers should build the consumers trust and increase security of the website to increase and maintain the consumers loyalty.

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