Pre-arthroplastic and simultaneous mandibular distraction for correction of facial deformity in temporomandibular joint ankylosis

Abstract

a b s t r a c tIntroduction: In cases of temporomandibular joint (TMJ) ankylosis, interposition arthroplasty allows return of functional jaw movements. In order to improve the facial appearance, distraction osteogenesis is the treatment of choice, and may be timed either as a prearthroplastic, simultaneous or post-arthroplastic procedure. This study was planned to compare the treatment outcomes of pre-arthroplastic distraction (PAD) and simultaneous arthroplastic distraction (SAD) to establish the better treatment modality in terms of improvement in function and aesthetics. Materials and methods: This prospective randomized experimental study included 20 children and adolescents suffering from facial deformity due to long standing unilateral TMJ ankylosis. They were randomly allocated to the two surgical groups with ten in each group. Result: Both groups resulted in good facial symmetry and aesthetics. Initially, during the distraction period, mouth opening of SAD group scored less than that of PAD group but became comparable in 30 days. More pain at the distraction site and over the normal TMJ was observed in PAD group. The excursive movements were almost comparable in both the groups. Conclusion: We conclude that both procedures are effective in correcting the postankylotic deformity and improving function. Although PAD has better control over movement of the distracting segment, the contralateral TMJ may experience pain.SAD requires a shorter management period but is associated with a temporary decrease in function. Also, control of distraction may be difficult and chances of reankylosis are always there.

A systematic review on the outcome of distraction osteogenesis in TMJ ankylosis

“…The two RCTs included were by Chellappa et al, 3 where prearthroplasty and simultaneous arthroplasty mandibular distraction was compared, and other by Kaur et al 4 ) with random effect model (Fig. 2b).…”

“…Prearthroplastic DO 3,[23][24][25][26][27][28][29][30][31][32][33][34][35] : Pre-arthroplasty distraction is preferred for multiple reasons. It allows distraction against a stable fixed point, such that a true distraction of mandible occurs and that too in the desired direction only, and with a better vector control.…”

“…53 (Table 2) However prearthroplasty DO has been found to be associated with more pain in the contralateral normal TMJ during the course of DO. 3 Practically and ideally Prearthroplastic DO is the best answer to TMJa.…”

Counter-Clockwise Rotation of Maxillomandibular Complex and Customized Joint Reconstruction as a Single Stage Management for Facial Deformity in Temporomandibular Joint Ankylosis: A 2 Year Follow-Up

“…7 Cases with associated facial deformity are either managed by a Le Fort I osteotomy and its inferior positioning ipsilaterally or bilaterally for correction of occlusal cant along with inverted L osteotomy of ramus or with pre-arthroplastic mandibular or maxillomandibular distraction osteogenesis (DO). 8 –11…”

Mandibular distraction osteogenesis in the treatment of pediatric temporomandibular joint ankylosis with micrognathia and obstructive sleep apnea syndrome: A case report with 4‑year follow‑up

“…Simultaneous arthroplasty and MDO enable the production of a neocondyle and allow for concomitant correction of facial malformations. The treatment outcomes of pre-arthroplastic distraction and simultaneous arthroplastic distraction have been previously compared and it was concluded that the two methods were effective in correcting the aesthetics of the patients and functional movement of the TMJ (13). Papageorge and Apostolidis (14) were the first to perform simultaneous gap arthroplasty and MDO for the treatment of micrognathia in ankyloses of the TMJ in 1999; as a result, mouth opening was improved and facial deformity was corrected.…”