Distraction osteogenesis for correction of post ankylosis mandibular deformities.

Khan Ahmed,Tandon Parul,Musheer Wamiq,Sohail Muhammad

doi:10.7555/jbr.29.20140073

Abstract

Temporomandibular joint ankylosis, a debilitating disease mainly affecting children, is characterized by progressive restriction of mouth opening and maxilla-mandibular developmental deformities. Craniofacial distraction osteogenesis has been developed as a standard surgical strategy for rectification of craniofacial deformities. The purpose of this study was to assess mono-planar distraction devices for the correction of various mandibular asymmetries in patients with unilateral temporomandibular joint ankylosis who developed restricted mouth opening and mandibular retrognathia. All patients were treated using one-stage distraction osteogenesis followed by temporalis fascia interpositional arthroplasty under general anesthesia. A significant increase in mandibular ramus and base length was observed. Although an increase in anterior lower facial height was observed, it was not significant statistically. A decrease in posterior lower facial height and corpus was observed. Oblique distraction with angular osteotomy allowed lengthening of both the ramus and corpus, yielding satisfactory results and hence eliminating the need of secondary surgery. In conclusion, univector internal distractors are effective for correction of multi-planar mandibular deficiencies by optimizing its placement through meticulous planning.

Highlights

Temporomandibular joint (TMJ) ankylosis is a prevalent cause of mandibular deformity and distortion in children due to trauma or infection[1]
All patients were treated using distraction osteogenesis followed by temporalis fascia interpositional arthroplasty under general anesthesia
If the advancement is more than 10 mm with conventional osteotomies, the inferior alveolar nerve would be stretched resulting in neurosensory deficit

Summary

Introduction

Temporomandibular joint (TMJ) ankylosis is a prevalent cause of mandibular deformity and distortion in children due to trauma or infection[1]. The major goals towards the treatment of TMJ ankylosis are to establish movement and functioning of the jaws, avoid relapse or setback and achieve normal growth, occlusion and deformity correction[2]. Untreated TMJ ankylosis in children may result in a significant functional and aesthetic adverse consequences including facial asymmetry. One of the major complications of TMJ ankylosis is mandibular retrognathia, giving rise to bird face deformity. It likewise causes inadequate delicate soft tissue of the lower third of the face and at the neck, deficiency of the neck angle and abbreviated suprahyoid muscles. While TMJ ankylosis essentially requires surgical arthrectomy, correction of growth lag can either be achieved through conventional orthognathic procedures, distraction osteogenesis or both

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