Staged Treatment of Temporomandibular Joint Ankylosis With Micrognathia Using Mandibular Osteodistraction and Advancement Genioplasty

Abstract

Distraction osteogenesis can be used to correct micrognathia after temporomandibular joint (TMJ) ankylosis. However, there is still some controversy over the proper sequencing of management for the ankylosed patients. The objective of the present study was to evaluate a staged treatment of TMJ ankylosis accompanied by micrognathia using arthroplasty, mandibular distraction osteogenesis, and advancement genioplasty. A total of 12 bilateral TMJ ankylosis patients with micrognathia (aged 17 to 27 years) underwent arthroplasty as the initial surgical procedure, followed by orthodontic treatment and correction of mandibular micrognathia by osteodistraction and advancement genioplasty as the second surgical procedure. The clinical results were evaluated by mouth opening, radiography, medical photography, and respiratory function. The patients were followed up for a minimum of 8 months to a maximum of 36 months. The TMJ ankylosis was released successfully in all the patients, showing an increase in average mouth opening from 3.3 mm preoperatively to 35.8 mm postoperatively. Micrognathia was corrected, and, remarkably, the obstructive sleep apnea and hypopnea syndrome was cured. Satisfactory occlusion was achieved with orthodontic treatment. Our data suggest that a staged and surgical orthodontic treatment might be a better approach to manage TMJ ankylosis accompanied by mandibular hypoplasia. In addition to mandibular osteodistraction, advancement genioplasty should be considered for better improvement in facial esthetics and respiratory function.