Evaluation of distraction osteogenesis for bilateral ankylosis of the temporomandibular joint after osteoarthrotomy

Abstract

Many cases of bilateral ankylosis of the temporomandibular joint treated by osteoarthrotomy, but in some cases with severe complications such as deformity, malocclusion, deviation, mandibular retreat symptom, etc. We have used distraction osteogenesis for cases of ankylosis after osteoarthrotomy to avoid the complications, particularly mandibular retreat symptom. In this study, we evaluated this new technique. The subjects were 20 patients, ranged in age from 23 to 45 years with the ankylosis of the temporomandibular joint. All cases were treated by osteoarthrotomy (high operation, gap arthroplasty) using with temporal fascia. About 1 year after osteoarthrotomy, we treated by distraction osteogenesis for mandibular retreat symptom. The L-shape osteotomy of the posterior mandibular ramus designed for this procedure. Active distraction was started after a latency period of 3 days with a rate of 0.5 mm twice daily. All patients ended with a symmetrical chin position and X-rays. In all cases over 5 years after operation, we achieved improved occlusion, no trismus, face symmetry and no anterior open bite. The new surgical treatment—distraction osteogenesis and osteoarthrotomy— is useful for patients with ankylosis of the temporomandibular joint.