Mandibular Distraction For Management

of Temporomandibular Joint (TMJ) Ankylosis

087 moxueyin

Introduction

• DO is a new and effective technique that offers an alternative to autogenous bone grafting and prosthetic total joint replacement in the treatment of TMJ.

Indications

• Patients with mandibular micrognathia accompanied by OSAHS secondary to TMJ ankylosis is the best indications of DO.

• Panoramic and cephalometric radiographs were taken at frist.

• Surgery for TMJ arthroplasty or reconstruction.• Orthodontic treatment begin after arthroplasty.• Surgical for correction of micrognathia using mandib

ular DO.

Treatment procedure

The initial surgery

• An individualized occlusal pad was made from self-curing acrylic resin intraoperatively according to the maximal mouth-opening.

The second surgery

single-stack or double-stack genioplasty was performed while insetting the distractor or removing the distractor at 12 weeks after distraction.

Preoperative

Postoperative

Long term result

• The long term effect of mandibular distractionosteogenesis on patients with temporomandibular joint (TMJ) ankylosis and mandibular micrognathia is safe and stable.

Advantages

• Ability to produce larger skeletal movements• Elimination of the need for bone grafts (secondary sur

gical site)• Better long-term stability• Less trauma to TMJ• Distraction of soft tissue along with lengthening the

bone

Disadvantages

• Two procedures.• Increased cost.• Longer Rx time, patient compliance

& frequent appointments.

Applications

• Infection• Scar • Facial nerve paralysis • The damage of temporomandibular

joint

Conclusion

As a relatively new surgical approach,DO is a feasible and safe method in the management of TMJ ankylosis with mandibular micrognathia and will play an important role in advanced head and neck reconstruction. The 3D craniomaxillofacial model is helpful for DO accuracy and success.

References 1.Ping Feiyun,Liu Wei, Chen Jun, Xu Xin, Shi Zhu ,Fengguo.Simultaneous Correction

of Bilateral Temporomandibular Joint Ankylosis With Mandibular Micrognathia Using Internal DistractionOsteogenesis and 3-Dimensional Craniomaxillofacial Models.

2.Sven Erik Nørholt, John Jensen,Søren Schou, Thomas Klit Pedersen, Complications after mandibular distractionosteogenesis: a retrospective study of 131 patients.

3.P. Anantanarayanan, V. Narayanan, R. Manikandhan, D. Kumar

Primary mandibular distraction for management of nocturnal desaturations secondary to temporomandibular joint (TMJ) ankylosis Int J Pediatr Otorhinolaryngol, 72 (2008), pp. 385–389.

4.R.F. Elgazzar, A.I. Abdelhady, K.A. Saad, M.A. Elshaal, M.M. Hussain, S.E. Abdelal et al.Treatment modalities of TMJ ankylosis: experience in Delta Nile, Egypt .Int J Oral Maxillofac Surg, 39 (2010), pp. 333–342.

5.B. Krishnan .Autogenous auricular cartilage graft in temporomandibular joint ankylosis – an evaluation.Oral Maxillofac Surg, 12 (2008), pp. 189–193.

References

6.H.C. Schwartz, R.J. Relle.Distraction osteogenesis for temporomandibular joint reconstruction.J Oral Maxillofac Surg, 66 (2008), pp. 718–723.

7.Hongtao Shang1, Yang Xue1, Yanpu Liu, Jinlong Zhao, LishenHe.Modified internal mandibular distraction osteogenesis in the treatment of micrognathia secondary to temporomandibular joint ankylosis: 4-Year follow-up of a case.

8.Tae-Geon Kwon,Hyo-Sang Park,Jong-Bae Kim, Hong-In Shin, Staged Surgical Treatment for Temporomandibular Joint Ankylosis: Intraoral Distraction After Temporalis Muscle Flap Reconstruction.

9.E. Xiao, Y. Zhang, J. An, J. Li, Y. Yan: Long-term evaluation of the stability of reconstructed condyles by transport distraction osteogenesis. Int. J. Oral Maxillofac.Surg. 2012.

10.Aysegul Mine Tuzuner-Oncul*, Reha S. Kisnisci,Response of ramus following vertical lengthening with distraction osteogenesis.