Transport distraction osteogenesis as a method of reconstruction of the temporomandibular joint following gap arthroplasty for post-traumatic ankylosis in children: a clinical and radiological prospective assessment of outcome |
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Affiliation: | 1. Oral Cancer Research and Coordinating Centre, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia;2. Department of Community Dentistry, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia;3. Regional Maxillofacial Unit, University Hospital Aintree, Liverpool, UK;4. Evidence-Based Practice Research Centre (EPRC), Faculty of Edge Hill University, Ormskirk, UK;1. Speciality Trainee Oral and Maxillofacial Surgery, University Hospitals of Birmingham Queen Elizabeth Hospital, Birmingham, West Midlands, B15 2TH;2. Consultant in Oral and Maxillofacial Surgery University Hospitals of Birmingham Queen Elizabeth Hospital, Birmingham, West Midlands, B15 2TH;1. Helmholtz-Zentrum Berlin, Hahn-Meitner-Platz 1, D-14109 Berlin, Germany;2. ESS Design Update Programme, Germany |
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Abstract: | This clinical and radiographic study investigated the use of transport distraction osteogenesis in unilateral temporomandibular joint (TMJ) ankylosis patients. Six patients aged between 4 and 8 years were selected for the study; the mean preoperative maximal inter-incisal opening (MIO) was 3.5 mm without lateral and protrusive mandibular movements. The ankylotic mass along with the posterior border of the ascending ramus was exposed via ‘lazy-S’ incision. A gap arthroplasty was performed, followed by a ‘reverse L’ osteotomy on the posterior border of the ramus. In-house manufactured extraoral distraction devices were used for this prospective study. Follow-up clinical and radiographic evaluation was carried out for 13–27 months after completion of the activation period. After a mean follow-up of 19 months, the mean MIO was 29.1 mm and the lateral and protrusive movements changed from none to slight. Cone beam computed tomography images of all patients showed remodelled neocondyle created by transport distraction osteogenesis with no statistically significant differences observed for average cancellous bone density, trabecular number, and trabecular spacing between the neocondyle of the operated side (test) and the condyle of the non-operated side (control). Neocondyle formation by transport distraction osteogenesis using the in-house distraction device is a promising treatment option for TMJ reconstruction in ankylosis patients. |
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Keywords: | temporomandibular joint (TMJ) ankylosis distraction osteogenesis TMJ reconstruction CBCT in-house distractors |
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