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

Yu,Xingna; Wang,Jianning; Hou,Shida; Zeng,Rongsheng

doi:10.3892/etm.2019.8119

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

Authors:
- Xingna Yu
- Jianning Wang
- Shida Hou
- Rongsheng Zeng
View Affiliations

Affiliations: Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat‑sen University, Guangzhou, Guangdong 510055, P.R. China
Published online on: October 22, 2019 https://doi.org/10.3892/etm.2019.8119
Pages: 4888-4892
Copyright: © Yu et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Temporomandibular joint (TMJ) ankylosis in pediatric patients is rare and may cause severe micrognathia and obstructive sleep apnea syndrome. The present study reports on the treatment and 4‑year follow‑up of a pediatric patient with early‑onset bilateral TMJ ankylosis and severe secondary micrognathia, as well as obstructive sleep apnea syndrome. A typical ‘bird face’ appearance was noted with severe mandible retrognathism and a significant convex facial profile. The treatment of this patient involved TMJ ankylosis release with condylectomy and simultaneous bilateral mandibular distraction osteogenesis, which enabled the surgeons to simultaneously reconstruct the neocondyle and correct facial malformations. Following treatment, the micrognathia was corrected and the oropharyngeal airway was significantly expanded. However, the maximal incisal opening was limited. During the 4‑year follow‑up, no signs of mandible retraction were noted and mouth opening increased to 17 mm (passive) compared with the inability to open that was noted immediately following surgery. A certain degree of MIO shrinkage was identified in the patient. In such cases of TMJ ankylosis, early post‑operative exercise, active post‑operative physiotherapy and stringent follow‑up are essential to prevent post‑operative shrinkage and adhesions.

View Figures

View References

1	Elgazzar RF, Abdelhady AI, Saad KA, Elshaal MA, Hussain MM, Abdelal SE and Sadakah AA: Treatment modalities of TMJ ankylosis: Experience in Delta Nile, Egypt. Int J Oral Maxillofac Surg. 39:333–342. 2010. View Article : Google Scholar : PubMed/NCBI
2	Chidzonga MM: Temporomandibular joint ankylosis: Review of thirty-two cases. Br J Oral Maxillofac Surg. 37:123–126. 1999. View Article : Google Scholar : PubMed/NCBI
3	Bookman LB, Melton KR, Pan BS, Bender PL, Chini BA, Greenberg JM, Saal HM, Taylor JA and Elluru RG: Neonates with tongue-based airway obstruction: A systematic review. Otolaryngol Head Neck Surg. 146:8–18. 2012. View Article : Google Scholar : PubMed/NCBI
4	Breik O, Tivey D, Umapathysivam K and Anderson P: Mandibular distraction osteogenesis for the management of upper airway obstruction in children with micrognathia: A systematic review. Int J Oral Maxillofac Surg. 45:769–782. 2016. View Article : Google Scholar : PubMed/NCBI
5	Karp NS, Thorne CH, McCarthy JG and Sissons HA: Bone lengthening in the craniofacial skeleton. Ann Plast Surg. 24:231–237. 1990. View Article : Google Scholar : PubMed/NCBI
6	Kaban LB, Bouchard C and Troulis MJ: A protocol for management of temporomandibular joint ankylosis in children. J Oral Maxillofac Surg. 67:1966–1978. 2009. View Article : Google Scholar : PubMed/NCBI
7	Resnick CM: Temporomandibular joint reconstruction in the growing child. Oral Maxillofac Surg Clin North Am. 30:109–121. 2018. View Article : Google Scholar : PubMed/NCBI
8	Gupta H, Tandon P, Kumar D, Sinha VP, Gupta S, Mehra H and Singh J: Role of coronoidectomy in increasing mouth opening. Natl J Maxillofac Surg. 5:23–30. 2014. View Article : Google Scholar : PubMed/NCBI
9	Yu H, Shen G, Zhang S and Wang X: Gap arthroplasty combined with distraction osteogenesis in the treatment of unilateral ankylosis of the temporomandibular joint and micrognathia. Br J Oral Maxillofac Surg. 47:200–204. 2009. View Article : Google Scholar : PubMed/NCBI
10	López EN and Dogliotti PL: Treatment of temporomandibular joint ankylosis in children: Is it necessary to perform mandibular distraction simultaneously? J Craniofac Surg. 15:879–884; discussion 884–885. 2004. View Article : Google Scholar : PubMed/NCBI
11	Sadakah AA, Elgazzar RF and Abdelhady AI: Intraoral distraction osteogenesis for the correction of facial deformities following temporomandibular joint ankylosis: A modified technique. Int J Oral Maxillofac Surg. 35:399–406. 2006. View Article : Google Scholar : PubMed/NCBI
12	Sharma A, Paeng JY, Yamada T and Kwon TG: Simultaneous gap arthroplasty and intraoral distraction and secondary contouring surgery for unilateral temporomandibular joint ankylosis. Maxillofac Plast Reconstr Surg. 38:122016. View Article : Google Scholar : PubMed/NCBI
13	Chellappa AL, Mehrotra D, Vishwakarma K, Mahajan N and Bhutia DP: Pre-arthroplastic and simultaneous mandibular distraction for correction of facial deformity in temporomandibular joint ankylosis. J Oral Biol Craniofac Res. 5:153–160. 2015. View Article : Google Scholar : PubMed/NCBI
14	Papageorge MB and Apostolidis C: Simultaneous mandibular distraction and arthroplasty in a patient with temporomandibular joint ankylosis and mandibular hypoplasia. J Oral Maxillofac Surg. 57:328–333. 1999. View Article : Google Scholar : PubMed/NCBI
15	Eski M, Deveci M, Zor F and Sengezer M: Treatment of temporomandibular joint ankylosis and facial asymmetry with bidirectional transport distraction osteogenesis technique. J Craniofac Surg. 19:732–739. 2008. View Article : Google Scholar : PubMed/NCBI
16	Peacock ZS, Salcines A, Troulis MJ and Kaban LB: Long-term effects of distraction osteogenesis of the mandible. J Oral Maxillofac Surg. 76:1512–1523. 2018. View Article : Google Scholar : PubMed/NCBI
17	Yin L, Tang X, Shi L, Yin H and Zhang Z: Mandibular distraction combined with orthognathic techniques for the correction of severe adult mandibular hypoplasia. J Craniofac Surg. 25:1947–1952. 2014. View Article : Google Scholar : PubMed/NCBI