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Simultaneous TMJ Ankylosis Release with Uniplanar Mandibular Distraction Osteogenesis for Correction of Facial Deformity and Obstructive Sleep Apnoea in Growing Patients: A Pilot Study

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Abstract

Aim

To evaluate the efficacy of simultaneous TMJ ankylosis (TMJA) release with uniplanar mandibular distraction in the management of facial deformity, improvement in function and obstructive sleep apnoea in growing patients.

Material and Methods

Ten patients in the age group of 5–15 years with unilateral/bilateral TMJA and mild to moderate OSA and short body length but ramus height within normal limits were treated with simultaneous ankylosis release and uniplanar mandibular distraction osteogenesis. Clinical, radiographic, and OSA parameters were evaluated and followed up for 1 year.

Results

Average mandibular body length increased by 16.6 mm, mouth opening by 26.9 mm, SNB angle by 9.53°, pharyngeal airway space by 6.29 mm, chin discrepancy corrected by 5.05 mm, apnoea–Hypopnoea index decreased by 15.9, N┴Pog by 12.27 mm, oxygen saturation (Spo2) by 4.1%, and oxygen desaturation index by 17.89%. All clinical, radiographic, and OSA parameters improved and were statistically significant except for mandibular plane angle and with minimal complications.

Conclusion

Simultaneous TMJA release with uniplanar mandibular Distraction osteogenesis may be recommended as the treatment of choice in growing patients with mild to moderate OSA and facial deformity, as it causes simultaneous correction of micrognathia, facial asymmetry, OSA and prevents the need for an additional surgery.

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References

  1. el-Sheikh MM, Medra AM, Warda MH (1996) Bird face deformity secondary to bilateral temporomandibular joint ankylosis. J Craniomaxillofac Surg 24(2):96–103. https://doi.org/10.1016/s1010-5182(96)80020-5

    Article  CAS  PubMed  Google Scholar 

  2. Mandell DL, Yellon RF, Bradley JP, Izadi K, Gordon CB (2004) Mandibular distraction for micrognathia and severe upper airway obstruction. Arch Otolaryngol Head Neck Surg 130(3):344–348. https://doi.org/10.1001/archotol.130.3.344

    Article  PubMed  Google Scholar 

  3. Dean A, Alamillos F (1999) Mandibular distraction in temporomandibular joint ankylosis. Plast Reconstr Surg 104(7):2021–2031. https://doi.org/10.1097/00006534-199912000-00012

    Article  CAS  PubMed  Google Scholar 

  4. Wu BZ, Ma L, Li Y, Chen S, Yi B (2017) Costochondral graft in young children with hemifacial microsomia. J Craniofac Surg 28(1):129–133. https://doi.org/10.1097/SCS.0000000000003268

    Article  PubMed  Google Scholar 

  5. Liu YP, Behrents RG, Buschang PH (2010) Mandibular growth, remodeling, and maturation during infancy and early childhood. Angle Orthod 80(1):97–105. https://doi.org/10.2319/020309-67.1

    Article  PubMed  PubMed Central  Google Scholar 

  6. Movahed R, Mercuri LG (2015) Management of temporomandibular joint ankylosis. Oral Maxillofac Surg Clin N Am 27(1):27–35. https://doi.org/10.1016/j.coms.2014.09.003

    Article  Google Scholar 

  7. Gachabayov M, Latifi R (2019) Patient satisfaction following thyroidectomy in surgical mission: a prospective study. Gland Surg 8(4):385–388. https://doi.org/10.21037/gs.2019.06.06

    Article  PubMed  PubMed Central  Google Scholar 

  8. López EN, Dogliotti PL (2004) Treatment of temporomandibular joint ankylosis in children: is it necessary to perform mandibular distraction simultaneously? J Craniofac Surg 15(5):879–885. https://doi.org/10.1097/00001665-200409000-00037

    Article  PubMed  Google Scholar 

  9. Mehrotra D, Kumar S, Dhasmana S (2012) Hydroxyapatite/collagen block with platelet rich plasma in temporomandibular joint ankylosis: a pilot study in children and adolescents. Br J Oral Maxillofac Surg 50(8):774–778. https://doi.org/10.1016/j.bjoms.2012.01.002

    Article  CAS  PubMed  Google Scholar 

  10. Anantanarayanan P, Narayanan V, Manikandhan R, Kumar D (2008) Primary mandibular distraction for management of nocturnal desaturations secondary to temporomandibular joint (TMJ) ankylosis. Int J Pediat Otorhinolaryngol 72(3):385–389. https://doi.org/10.1016/j.ijporl.2007.11.015

    Article  CAS  Google Scholar 

  11. Andrade NN, Kalra R, Shetye SP (2012) New protocol to prevent TMJ reankylosis and potentially life threatening complications in triad patients. Int J Oral Maxillofac Surg 41(12):1495–1500. https://doi.org/10.1016/j.ijom.2012.06.012

    Article  CAS  PubMed  Google Scholar 

  12. Anchlia S, Vyas SM, Dayatar RG, Domadia HL, Nagavadiya V (2019) Guidelines for single-stage correction of TMJ ankylosis, facial asymmetry and OSA in adults. J Maxillofac Oral Surg 18(3):419–427. https://doi.org/10.1007/s12663-018-1121-4

    Article  PubMed  Google Scholar 

  13. Gomez NL, Boccalatte LA, Lopez Ruiz Á, Nassif MG, Figari MF, Ritacco L (2021) Total temporomandibular joint replacement and simultaneous orthognathic surgery using computer-assisted surgery. J Maxillofac Oral Surg 20(3):394–403. https://doi.org/10.1007/s12663-020-01422-y

    Article  PubMed  Google Scholar 

  14. Garg N, Anchlia S, Dhuvad J, Gosai H, Chaudhari P (2022) Bilateral biplanar distraction osteogenesis in facial deformity secondary to temporomandibular ankylosis. J Maxillofac Oral Surg 21(3):939–947. https://doi.org/10.1007/s12663-020-01502-z

    Article  PubMed  Google Scholar 

  15. Kaban LB, Perrott DH, Fisher K (1990) A protocol for management of temporomandibular joint ankylosis. J Oral Maxillofac Surg 48(11):1145–1152. https://doi.org/10.1016/0278-2391(90)90529-b

    Article  CAS  PubMed  Google Scholar 

  16. Papageorge MB, Apostolidis C (1999) Simultaneous mandibular distraction and arthroplasty in a patient with temporomandibular joint ankylosis and mandibular hypoplasia. J Oral Maxillofac Surg 57(3):328–333. https://doi.org/10.1016/s0278-2391(99)90683-3

    Article  CAS  PubMed  Google Scholar 

  17. Azumi Y, Sugawara J, Takahashi I, Mitani H, Nagasaka H, Kawamura H (2004) Positional and morphologic changes of the mandibular condyle after mandibular distraction osteogenesis in skeletal class II patients. World J Orthod 5(1):32–39

    PubMed  Google Scholar 

  18. Rao K, Kumar S, Kumar V, Singh AK, Bhatnagar SK (2004) The role of simultaneous gap arthroplasty and distraction osteogenesis in the management of temporo-mandibular joint ankylosis with mandibular deformity in children. J Craniomaxillofac Surg 32(1):38–42. https://doi.org/10.1016/j.jcms.2003.07.003

    Article  PubMed  Google Scholar 

  19. Yu H, Shen G, Zhang S, Wang X (2009) Gap arthroplasty combined with distraction osteogenesis in the treatment of unilateral ankylosis of the temporomandibular joint and micrognathia. Br J Oral Maxillofac Surg 47(3):200–204. https://doi.org/10.1016/j.bjoms.2008.08.003

    Article  PubMed  Google Scholar 

  20. Wang X, Wang XX, Liang C, et al. (2003) Distraction osteogenesis in correction of micrognathia accompanying obstructive sleep apnea syndrome. Plast Reconstr Surg 112(6):1549–1557, discussion 1558–9. https://doi.org/10.1097/01.prs.0000086734.74795.c4

  21. Giraddi GB, Arora K, Sai Anusha AJ (2016) Distraction osteogenesis in the treatment of temporomandibular joint ankylosis with mandibular micrognathia. Ann Maxillofac Surg 6(1):68–74. https://doi.org/10.4103/2231-0746.186125

    Article  PubMed  PubMed Central  Google Scholar 

  22. Tomonari H, Takada H, Hamada T, Kwon S, Sugiura T, Miyawaki S (2017) Micrognathia with temporomandibular joint ankylosis and obstructive sleep apnea treated with mandibular distraction osteogenesis using skeletal anchorage: a case report. Head Face Med 13(1):20. https://doi.org/10.1186/s13005-017-0150-4

    Article  PubMed  PubMed Central  Google Scholar 

  23. Yadav R, Bhutia O, Shukla G, Roychoudhury A (2014) Distraction osteogenesis for management of obstructive sleep apnoea in temporomandibular joint ankylosis patients before the release of joint. J Craniomaxillofac Surg 42(5):588–594. https://doi.org/10.1016/j.jcms.2013.07.031

    Article  PubMed  Google Scholar 

  24. Sadakah AA, Elgazzar RF, Abdelhady AI (2006) Intraoral distraction osteogenesis for the correction of facial deformities following temporomandibular joint ankylosis: a modified technique. Int J Oral Maxillofac Surg 35(5):399–406. https://doi.org/10.1016/j.ijom.2006.01.013

    Article  CAS  PubMed  Google Scholar 

  25. Kunz C, Hammer B, Prein J (2000) Manipulation of callus after linear distraction: a “lifeboat” or an alternative to multivectorial distraction osteogenesis of the mandible? Plast Reconstr Surg 105(2):674–679. https://doi.org/10.1097/00006534-200002000-00029

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

We are thankful to the department of Pulmonary Medicine for doing the sleep study of all patients and special thanks to Dr. Khushali Shah for doing biostatistics.

Funding

This study was not supported by any funding.

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Authors and Affiliations

  1. Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Ahmedabad, Gujarat, India

    Pratesh Dholabhai, Sonal Anchlia, Jigar Dhuvad, Utsav Bhatt, Ankita Nakrani & Jimmy Kania

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  1. Pratesh Dholabhai
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  2. Sonal Anchlia
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  3. Jigar Dhuvad
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  4. Utsav Bhatt
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  5. Ankita Nakrani
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Contributions

Dr. PD did all pre-operative preparations and history taking including post-operative care, proper follow-up and maintained the record as well as wrote this paper, Dr. SA planned and performed surgery and reviewed the paper entirely, Dr. JD planned and performed surgery and reviewed introduction, materials and methodology of paper. Dr. UB reviewed paper critically in discussion and conclusion aspects and Dr. AN and JK positively contributed to write the paper.

Corresponding author

Correspondence to Pratesh Dholabhai.

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None of the authors has any conflicts of interest.

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Study was approved by the Institutional Ethical Committee.

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Dholabhai, P., Anchlia, S., Dhuvad, J. et al. Simultaneous TMJ Ankylosis Release with Uniplanar Mandibular Distraction Osteogenesis for Correction of Facial Deformity and Obstructive Sleep Apnoea in Growing Patients: A Pilot Study. J. Maxillofac. Oral Surg. 22, 333–343 (2023). https://doi.org/10.1007/s12663-023-01857-z

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  • DOI: https://doi.org/10.1007/s12663-023-01857-z

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