Distraction osteogenesis and orthognathic surgery in the treatment of bilateral temporomandibular joint ankylosis

ABSTRACT

Bilateral temporomandibular joint TMJ ankylosis during the active growth period presents with a conglomerate of clinical features namely severe micrognathia, inability to open the mouth and upper airway obstruction. Early treatment is recommended to avoid the secondary affection of the maxilla and midface. Six patients with bilateral TMJ ankylosis were included in this study. They were divided equally into two groups. The standard treatment was followed in group I which consisted of the release of ankylosis as a primary procedure. After an appropriate period of physiotherapy, mandibular osteotomy with iliac bone grafts and advancement genioplasty was performed in the mandible and Le Fort I osteotomy in the maxilla to correct maxillary canting. As for the cases in group II, mandibular advancement by means of distraction osteogenesis were carried out first by means of two extraoral multi-guide distractors fixed bilaterally to the mandible followed by the release of ankylosis. Evaluation included clinical examination, photography and radiographic analysis [orthopantomogram, lateral and posteroanterior cephalometry]. The distraction gap was assessed by means of ultrasonography and ultrasonometry. Dexa was used in one case. The advantages of both procedures are discussed