Orthomorphic surgery for correction of mandibular dysmorphology post TMJ ankylosis - A report of 4 cases and review of literature

Abstract

Mandibular dysmorphology is predominantly a result of uncoordinated growth deficiency or surfeit. Unilateral temporomandibular joint ankylosis during the active growth phase, if left unoperated, brings about changes in the size and shape of the mandible and the surrounding structures. The use of orthognathic surgery in correcting the facial deformities arising from discrepancies in spatial relationships although well accepted is unable to correct anomalies arising from an altered morphology. The surgical correction using orthomorphic principles restore the morphology without changing the occlusal status, thus proving to be an invaluable addition to a maxillofacial surgeon's repertoire.Four patients previously operated on for unilateral temporomandibular ankylosis having mandibular asymmetry were managed by orthomorphic correction. The etiological factor in all the recruited patients was trauma to the temporomandibular joint during childhood. The patients were evaluated for neurosensory changes, assessment of mouth opening before and after surgery, postoperative assessment of mandibular symmetry, and postoperative complications on 3 rd day, 3 weeks, and 3 months postoperatively. Good to moderate asymmetry correction was seen in all the cases. Mental nerve paraesthesia was noted in one patient. No postoperative complications were noted.The described technique can be used as a complement to conventional orthognathic surgery or as a reliable single-stage treatment alternative for complex dysmorphic entities.