Mandibular Distraction For
Management
of Temporomandibular Joint (TMJ)
Ankylosis
087 moxueyin
Introduction
• DO is a new and effective
technique that offers an alternative
to autogenous bone grafting and
prosthetic total joint replacement
in the treatment of TMJ.
Indications
• Patients with mandibular
micrognathia accompanied by
OSAHS secondary to TMJ
ankylosis is the best indications
of DO.
Treatment procedure
• Panoramic and cephalometric radiographs were taken
at frist.
• Surgery for TMJ arthroplasty or reconstruction.
• Orthodontic treatment begin after arthroplasty.
• Surgical for correction of micrognathia using
mandibular DO.
The initial surgery
• An individualized occlusal pad was
made from self-curing acrylic resin
intraoperatively according to the
maximal mouth-opening.
The second surgery
single-stack or doublestack genioplasty was
performed while insetting
the distractor or removing
the distractor at 12 weeks
after distraction.
Preoperative
Postoperative
Long term result
• The long term effect of mandibular
distractionosteogenesis on patients
with temporomandibular joint (TMJ)
ankylosis and mandibular
micrognathia is safe and stable.
Advantages
• Ability to produce larger skeletal movements
• Elimination of the need for bone grafts (secondary
surgical site)
• Better long-term stability
• Less trauma to TMJ
• Distraction of soft tissue along with lengthening the
bone
Disadvantages
• Two procedures.
• Increased cost.
• Longer Rx time, patient compliance
& frequent appointments.
Applications
•
•
•
•
Infection
Scar
Facial nerve paralysis
The damage of temporomandibular
joint
Conclusion
As a relatively new surgical
approach,DO is a feasible and safe
method in the management of TMJ
ankylosis with mandibular micrognathia
and will play an important role in
advanced head and neck reconstruction.
The 3D craniomaxillofacial model is
helpful for DO accuracy and success.
References
1.Ping Feiyun,Liu Wei, Chen Jun, Xu Xin, Shi Zhu ,Fengguo.Simultaneous Correction
of Bilateral Temporomandibular Joint Ankylosis With Mandibular Micrognathia
Using Internal DistractionOsteogenesis and 3-Dimensional Craniomaxillofacial
Models.
2.Sven Erik Nørholt, John Jensen,Søren Schou, Thomas Klit Pedersen, Complications
after mandibular distractionosteogenesis: a retrospective study of 131 patients.
3.P. Anantanarayanan, V. Narayanan, R. Manikandhan, D. Kumar
Primary mandibular distraction for management of nocturnal desaturations
secondary to temporomandibular joint (TMJ) ankylosis Int J Pediatr
Otorhinolaryngol, 72 (2008), pp. 385–389.
4.R.F. Elgazzar, A.I. Abdelhady, K.A. Saad, M.A. Elshaal, M.M. Hussain, S.E. Abdelal
et al.Treatment modalities of TMJ ankylosis: experience in Delta Nile, Egypt .Int J
Oral Maxillofac Surg, 39 (2010), pp. 333–342.
5.B. Krishnan .Autogenous auricular cartilage graft in temporomandibular joint
ankylosis – an evaluation.Oral Maxillofac Surg, 12 (2008), pp. 189–193.
References
6.H.C. Schwartz, R.J. Relle.Distraction osteogenesis for temporomandibular joint
reconstruction.J Oral Maxillofac Surg, 66 (2008), pp. 718–723.
7.Hongtao Shang1, Yang Xue1, Yanpu Liu, Jinlong Zhao, LishenHe.Modified
internal mandibular distraction osteogenesis in the treatment of micrognathia
secondary to temporomandibular joint ankylosis: 4-Year follow-up of a case.
8.Tae-Geon Kwon,Hyo-Sang Park,Jong-Bae Kim, Hong-In Shin, Staged Surgical
Treatment for Temporomandibular Joint Ankylosis: Intraoral Distraction After
Temporalis Muscle Flap Reconstruction.
9.E. Xiao, Y. Zhang, J. An, J. Li, Y. Yan: Long-term evaluation of the stability of
reconstructed condyles by transport distraction osteogenesis. Int. J. Oral
Maxillofac.Surg. 2012.
10.Aysegul Mine Tuzuner-Oncul*, Reha S. Kisnisci,Response of ramus following
vertical lengthening with distraction osteogenesis.