Distraction Osteogenesis ,A New Hope For Tmj Ankylosis

Volume 2 Issue 1
February 2011
TMJ ankylosis treatment using distraction osteogenesis
Case Report
Distraction Osteogenesis ,A New Hope For Tmj Ankylosis
Dr. Amarnath.B.C , M.D.S* , Dr. Dharma R.M.,M.D.S**,
Dr. Prashanth C.S.,M.D.S*** Dr. Rajkumar G.C.,M.D.S#
* Professor, ** Professor , *** Professor, D.A.P.M.R.V. Dental College, Bangalore.
#
Professor, Oral and Maxillofacial Surgery ,V.S. Dental College
ABSTRACT
This case report presents the results of extraoral mandibular distraction
osteogenesis and gap arthroplasty in a patient with biilateral
temporomandibular joint bony ankylosis. Distraction osteogenesis with gap
arthroplasty proved successful in this patient with follow-up of longer than 2
years.
Keywords : Distraction Osteogenesis, TMJ ankylosis, Gap Arthroplasty
Journal of Dental Sciences & Research 2:1: Pages 108-115
life. The treatment of the sequelae
INTRODUCTION
of
Ankylosis of the TMJ is a common
pathology
affecting
skeleton,
which
the
facial
often
gets
overlooked
during
age,thereby
creating
younger
a
more
complex situation making it difficult
to manage during the later years of
bilateral
temporomandibular
ankylosis is difficult, because these
patients present with significant
micrognathia, and it is impossible
to use the conventional techniques
for mandibular augmentation.
The latest technique for combating
the
same
Osteogenesis”.
108 Journal of Dental Sciences and Research
is
“Distraction
Distraction
Volume 2 Issue 1
February 2011
TMJ ankylosis treatment using distraction osteogenesis
techniques have been used in the
arthroplasty
and
distraction
facial bone area for the past 10
osteogenesis was carried out.
years.1,2
CASE REPORT
Distraction osteogenesis (DO) is a
biologic
process
of
new
bone
formation by gradual traction of a
fracture
callus
formed
between
osteotomised bone segments.3-5
The
patient,a
16
yr
old
boy,reported to the Department of
Orthodontics
and
Dentofacial
Orthopaedics
with
the
chief
complaint of an inability to open
Bone
lengthening
by
osteotomy
the
mouth.Thorough
clinical
of
examination revealed the cause as
long bones was first described by
bilateral TMJ ankylosis.The patient
Codivilla6 and later popularized by
had a convex profile,recessive chin
Ilizarov.7 DO has been applied to
and high clinical FMA.(Fig 1)
and
the
distraction
craniofacial
osteogenesis
region
since
McCarthy et al reported the first
clinical application of the technique
in the treatment of four children
with either unilateral or bilateral
On
intraoral
examination,
Cl
molar relation was noted bilaterally
with posterior open bite.The upper
incisors were retroclined and the
lower incisors were proclined.15
mandibular hypoplasia.8
mm
of
overjet
This case report describes a 16 yr
overbite
was
old male patient with bilateral TMJ
opening was restricted to 8 mm.
ankylosis
and
severe
I
bilateral
mandibular hypoplasia. Orthodontic
treatment in combination with gap
109 Journal of Dental Sciences and Research
and
3
mm
of
present.Mouth
TMJ ankylosis treatment using distraction osteogenesis
Volume 2 Issue 1
February 2011
Fig 1 : Pretreatment extraoral photographs showing bird beak face, with a mouth opening
of 8mm and overjet of 15mm
The treatment was carried out in
three phases :
PHASE
I
:
Bilateral
gap
arthroplasty with Temporalis graft
interposition was carried out , to
relieve the TMJ ankylosis.(Fig
2).9The patient was also instructed
to carry out certain mouth opening
exercises using spring loaded
acrylic plates
to improve the
function. Mandibular distraction
osteogenesis was then carried out
using
Bilateral
Extraoral
unidirectional distractors (Fig 4).10
110 Journal of Dental Sciences and Research
TMJ ankylosis treatment using distraction osteogenesis
Volume 2 Issue 1
February 2011
FIG. 2: CONDYLECTOMY PROCEDURE
FIG 3: POST SURGICAL MOUTH OPENING OF 26 MM
FIG 4 : PLACEMENT OF EXTRAORAL DISTRACTORS
111 Journal of Dental Sciences and Research
TMJ ankylosis treatment using distraction osteogenesis
Volume 2 Issue 1
February 2011
Fig 5 : post distraction extra oral and intraoral photographs
112 Journal of Dental Sciences and Research
TMJ ankylosis treatment using distraction osteogenesis
PHASE II: It consisted of the
functional appliance phase in which
the Frankel 2 appliance was used
to allow functional modulation of
Volume 2 Issue 1
February 2011
the orofacial capsular matrix to
prevent relapse , reankylosis and
also aid in mouth opening.(Fig 6).
FIG 6 :Tthe Frankel 2 appliance to prevent relapse due to abnormal pressure from orofacial
musculature during the retention phase.
PHASE III : Fixed
mechanotherapy was initiated after
1 year of Frankel 2 appliance
wear(Fig 7), for aligning and
establishment of occlusion using
022 MBT appliance.
Fig 7 : intraoral photographs showing intiation of fixed mechanotherapy
113 Journal of Dental Sciences and Research
TMJ ankylosis treatment using distraction osteogenesis
Volume 2 Issue 1
February 2011
Fig 8 : 1 year post retention extraoral and intraoral photographs, showing stable results.
DISCUSSION
There was significant improvement
obtained by employing Distraction
Osteogenesis for this case,none of
the other Orthodontic or combined
Orthognathic approaches would
have given the same results.
Probably the use of a multidirectional distractor would have
given better results in terms of
reduced open bite to be managed
post distraction.
CONCLUSION
The patient described here showed
favourable results in terms of
function and aesthetics(Fig 8).
Without the osteogenic distraction
process, the results we achieved
would not have been the same,
since success with other
114 Journal of Dental Sciences and Research
TMJ ankylosis treatment using distraction osteogenesis
mandibular augmentation
techniques are limited . Although it
represents a new kind of technique
with several questions still
unanswered, osteogenic distraction
is the best indicated treatment in
such patients.
Volume 2 Issue 1
February 2011
mandibular distraction. Cleft Palate
Craniofac J. 2003;40:233–240.
6. Codivilla A. On the means of
lengthening, in the lower limbs,the
muscles and tissues which are
shortened through deformity.1904.
Clin Orthop Relat Res 1994;301:4–
9
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SA. Distraction osteogenesis. N Y
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Lengthening of the human
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115 Journal of Dental Sciences and Research