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a Stereolithographic model showing the preoperative placement of distractor and osteotomy cut. b Acrylic jig made on the model
Source publication
Purpose
Unilateral or bilateral ankylosis can lead to severe micrognathia and facial deformity that requires multiple, often, staged surgical corrections. To date, there is no ideal treatment modality that satisfactorily corrects the complex anatomy, restores the ramal height, and corrects the micrognathia and microgenia. Distraction osteogenesis h...
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Purpose:
The costochondral graft (CCG) is considered the reference standard for pediatric temporomandibular joint reconstruction. It has the disadvantages of unpredictable growth, donor site morbidity, and the need for intermaxillary fixation. It has been reported that transport disk distraction osteogenesis (TDDO) can result in the formation of a...
Mandibular condyle and glenoid fossa fusion results in temporomandibular joint (TMJ) ankylosis.
Paediatric TMJ ankylosis has a negative impact on facial growth, resulting in micrognathia, dental malocclusions, and sometimes facial asymmetry, which leads to significant morbidity.
We present a case of a bilateral TMJ ankylosis with an infectious od...
Temporomandibular joint (TMJ) ankylosis is a serious disabling condition characterized by fusion of the mandibular condyle with the glenoid fossa, disc, and/or eminence, resulting in severely restricted mouth opening and significantly reduced mandibular movements. The condition often has a deteriorating effect on the patient’s daily functions such...
Citations
... Distraction osteogenesis (DO) can be successfully employed to correct the associated mandibular hypoplasia. Performing distraction osteogenesis to advance the mandible in patients with history of simple gap arthroplasty has been observed to be inadequate owing to poor control over the unstable proximal segment and vector of distraction, resulting in failure of desired advancement [4]. Reconstruction with alloplastic joint and application of dual distraction technique may help stabilize the proximal segment and rectify the problem [5]. ...
... Simultaneous release of ankylosis, reconstruction of joint and distraction of ramus may hinder aggressive physiotherapy due to presence of distractor device which predisposes the joint for reankylosis [4]. ...
... Despite high expenses and need for second surgery for removal of distractor, pre-release distraction osteogenesis is the preferred method for correction of mandibular hypoplasia owing to the stability of the ankylosed proximal segment and planned movement of tooth-bearing segment [4]. Cases which have not been corrected with this method have poor proximal control leading to difficulty in achieving ideal results with conventional orthognathic and distraction osteogenesis techniques. ...
AimsThe current manuscript explores the viability of reverse sagittal split osteotomy technique for correction of ankylotic cases with post gap arthroplasty mandibular retrognathia to achieve socially acceptable esthetic results.
Method
Reverse sagittal split osteotomy which was introduced by Collins et al in 1983 was performed with certain modifications on two cases to correct mandibular hypoplasia in post gap arthroplasty cases. The paper also highlights intraoral as well as extraoral approach for performing the osteotomy along with better management of bad split under direct visionResultIt was observed that the reverse sagittal split technique for advancement of mandible in cases of tmj ankylosis-induced dentofacial deformity provided better proximal control, reduced chances of bad split, greater range of advancement (11–14 mm) with esthetically acceptable results. The osteotomy cuts on lateral surface of mandible make the procedure effectively easier and quicker with better control over proximal segment and management under direct vision.Conclusion
When Distraction Osteogenesis and conventional orthognathic is not a choice in management of dentofacial deformity of post-release ankylosis cases due to the poor proximal control and concern over bad split, reverse sagittal split can be an appropriate choice to manage these deformities without any donor site morbidity.
... DO has various advantages over conventional osteotomies in complex facial asymmetries. Pre-arthroplastic distraction in ankylosis-related asymmetries has been reported to have excellent results [43]. This is because simultaneous distraction of skin, muscle, and tissue takes place with bone regeneration. ...
Any abnormality of the soft or hard tissues of the face can lead to asymmetry. This could be a consequence of a congenital anomaly, a developmental or an acquired defect. Asymmetry can be progressive in nature, while those acquired due to trauma or ablative surgeries are non- progressive. It is prudent for the clinician to consider the aetiology of the asymmetry, the extent and its severity in all three dimensions in order to provide an optimal treatment plan. Besides, it is important to take into consideration factors such as growth, timing of treatment and psychological aspirations of the patients. The present chapter will discuss the etiopathogenesis and classifications, clinical considerations and diagnosis, evaluation and treatment planning of facial asymmetries. Few interesting case scenarios will also be discussed for a better understanding of clinical presentations and various surgical procedures available for management.
