Transport Distraction Osteogenesis for Reconstruction of Ramus-Condyle Unit following Release of Temporomandibular Joint ankylosis

Abstract

INTRODUCTION:Temporomandibular joint (TMJ) is a structurally complex joint. TMJ deficiency and deformity can result from different causes. Ankylosis of the TMJ is considered the most common cause leading to severe form of deformity and shortening of the ramus / condyle unit which can affect both, function and esthetic and is difficult to treat. Different surgical procedures have been used to treat this deficiency, with variable degrees of success rates. Distraction osteogenesis is a well-established technique that is used to treat different maxillofacial deformities. A recent use in reconstruction of the deficiency ramus-condyle unit is developed Aim: The objective of this study was to evaluate the use of transport distraction osteogenesis in restoring the deficient condyle/ramus unit of patients with unilateral or bilateral TMJ ankylosis to correct the resultant deformity. MATERIALS AND METHODS: Ten patients with TMJ ankylosis underwent Transport condylar ramus distraction osteogenesis to reconstruct the condyle after release and gap arthroplasty. The distractors used were extraoral submerged ones. Patients were randomly allocated into two groups. The first group transport condylar distraction was done immediately in the same operation after release of ankylosis. In the second group, distraction was done in a second stage. RESULTS: Our patients' age ranged from 2 to 46 years with an average of 18.2years. The follow-up period ranged from 15 to 60 months with an average of 30.2 months. Successful treatment was achieved in seven cases. Complications were mild in two, moderate in four and severe in three. CONCLUSIONS: Transport condylar distraction osteogenesis is a valuable treatment option for TMJ ankylosis. It has a considerable complication rate that must be considered and discussed thoroughly with the patient/guardian. Also, improvement of the design and handling characteristics of the distractors must be considered.