Simultaneous correction of bilateral temporomandibular joint ankylosis with mandibular micrognathia using internal distraction osteogenesis and 3-dimensional craniomaxillofacial models.

PURPOSE The present study evaluated the simultaneous correction of bilateral temporomandibular joint ankylosis with mandibular micrognathia using internal distraction osteogenesis (DO) with the help of a 3-dimensional craniomaxillofacial model technique. MATERIALS AND METHODS A total of 16 patients (age 18 to 43 years) with bilateral temporomandibular joint ankylosis and mandibular micrognathia were included in the present study. Obstructive sleep apnea and hypopnea syndrome was diagnosed in all patients preoperatively. Three-dimensional craniomaxillofacial models of the 16 patients were constructed using computed tomography and a rapid prototype technique. Simulation surgery and individual internal DO was performed on the models. The treatment included simultaneous DO of the mandibular body and transport DO for temporomandibular joint arthroplasty. The distraction was started on the seventh day after surgery. The distraction rate was 0.8 mm/day. The patients began active mouth opening postoperatively. Distracters were kept in place for 4 months after distraction completion and then removed. Polysomnography, cephalometry, and computed tomography were performed at 6 months postoperatively. RESULTS The obstructive sleep apnea and hypopnea syndrome was cured, and the micrognathia was corrected in all patients. The average mouth opening increased from 4.6 mm preoperatively to 33.5 mm postoperatively. The average range of the sella-nasion-supramental angle increased from 68.7 degrees preoperatively to 77.6 degrees postoperatively. Bone formation in the distraction gaps was observed. The follow-up period was 29.7 months (range 6 to 52). No complications or recurrence of temporomandibular joint ankylosis or micrognathia occurred in any patient during the follow-up period. CONCLUSIONS Bilateral temporomandibular joint ankylosis accompanied by mandibular micrognathia and obstructive sleep apnea and hypopnea syndrome can be corrected effectively by simultaneous internal DO. The application of preoperative simulation surgery using 3-dimensional craniomaxillofacial model has many advantages for planning the surgical method and precise operation. Our preliminary results have shown that it is a safe, effective, and feasible technique.

[1]  J. Hukki,et al.  Vector control in lower jaw distraction osteogenesis using an extra-oral multidirectional device. , 2001, Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

[2]  T M Barker,et al.  Stereolithographic (SL) biomodelling in craniofacial surgery. , 1998, British journal of plastic surgery.

[3]  Biao Yi,et al.  Distraction Osteogenesis in Correction of Micrognathia Accompanying Obstructive Sleep Apnea Syndrome , 2003, Plastic and reconstructive surgery.

[4]  M. M. El-Sheikh,et al.  Management of unilateral temporomandibular ankylosis associated with facial asymmetry. , 1997, Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

[5]  A. Sadakah,et al.  Intraoral distraction osteogenesis for the correction of facial deformities following temporomandibular joint ankylosis: a modified technique. , 2006, International journal of oral and maxillofacial surgery.

[6]  M. Urata,et al.  Facial nerve paralysis: a complication of distraction osteogenesis of the mandibular ramus in the treatment of temporomandibular joint ankylosis. , 2007, The Journal of craniofacial surgery.

[7]  M. Carskadon,et al.  Guidelines for the multiple sleep latency test (MSLT): a standard measure of sleepiness. , 1986, Sleep.

[8]  D. Preciado,et al.  Mandibular distraction to relieve airway obstruction in children with cerebral palsy. , 2004, Archives of otolaryngology--head & neck surgery.

[9]  A. Dean,et al.  Mandibular distraction in temporomandibular joint ankylosis. , 1999, Plastic and reconstructive surgery.

[10]  F. J. Nieto,et al.  The association of sleep-disordered breathing and sleep symptoms with quality of life in the Sleep Heart Health Study. , 2001, Sleep.

[11]  Steven R. Cohen,et al.  Mandibular Distraction Osteogenesis in the Treatment of Upper Airway Obstruction in Children with Craniofacial Deformities , 1998, Plastic and reconstructive surgery.

[12]  J. Y. Choi,et al.  Analysis of errors in medical rapid prototyping models. , 2002, International journal of oral and maxillofacial surgery.

[13]  S. Chopra,et al.  The role of distraction osteogenesis in mandibular reconstruction , 2007, Current opinion in otolaryngology & head and neck surgery.

[14]  K. Ueda,et al.  Mandibular Contour Reconstruction With Three-Dimensional Computer-Assisted Models , 2001, Annals of plastic surgery.

[15]  J. Marsh,et al.  Effect of Distraction Osteogenesis of the Mandible on Upper Airway Volume and Resistance in Children with Micrognathia , 2002, Plastic and reconstructive surgery.

[16]  A. Figueroa,et al.  A longitudinal three-dimensional evaluation of the growth pattern in hemifacial microsomia treated by mandibular distraction osteogenesis: a preliminary report. , 1999, The Journal of craniofacial surgery (Print).

[17]  A. Ysunza,et al.  Distraction Osteogenesis in Pierre Robin Sequence and Related Respiratory Problems in Children , 2002, The Journal of craniofacial surgery.

[18]  J. McCarthy,et al.  Controlled Multiplanar Distraction of the Mandible: Device Development and Clinical Application , 1998, The Journal of craniofacial surgery.