title: Combined surgical therapy of temporomandibular joint ankylosis and secondary deformity using intraoral distraction.
abstract: Temporomandibular joint (TMJ) ankylosis is a pathological process caused by damage of the mandibular condyle. When this event takes place in subjects during the developmental age, it results in an alteration of the entire maxillofacial complex. Therefore, surgical methods able to remove the temporomandibular ankylosis also include necessary operations to correct the secondary maxillofacial deformity. The distraction osteogenesis has induced our center to modify the surgical protocol for the therapy of patients who have developed TMJ ankylosis and secondary maxillomandibular deformity. We have treated four patients with monolateral ankylosis of the TMJ and serious deformities of the maxillomandibular complex secondary to functional limitation. During the same operation, arthroplasty was performed with the removal of the ankylotic block and the interposition of a temporal muscle flap in the new articular space; an intraoral osteodistractor was also positioned to lengthen the mandible. All patients showed recovery of the eurhythmy of the face and good re-establishment of the symmetry. An average 12-month follow-up showed the average opening of the mouth to be at least 35 mm. The combination of TMJ arthroplasty and intraoral osteodistraction provides good functional and aesthetic results in patients affected by ankylosis who have developed secondary maxillofacial deformities.
authors.affiliation: Department of Maxillofacial Surgery, Universitá degli Studi di Roma La Sapienza, Italy.
authors.forename: Piero
authors.initials: P
authors.lastname: Cascone
authors.forename: Cascone
authors.initials: C
authors.lastname: Piero
authors.forename: Alessandro
authors.initials: A
authors.lastname: Agrillo
authors.forename: Agrillo
authors.initials: A
authors.lastname: Alessandro
authors.forename: Giorgio
authors.initials: G
authors.lastname: Spuntarelli
authors.forename: Spuntarelli
authors.initials: S
authors.lastname: Giorgio
authors.forename: Paolo
authors.initials: P
authors.lastname: Arangio
authors.forename: Arangio
authors.initials: A
authors.lastname: Paolo
authors.forename: Giorgio
authors.initials: G
authors.lastname: Iannetti
authors.forename: Iannetti
authors.initials: I
authors.lastname: Giorgio
mesh_terms: D000293:Adolescent; D000844:Ankylosis / Q000503:physiopathology / Q000601:surgery*; D001178:Arthroplasty / Q000379:methods; D002648:Child; D002985:Clinical Protocols; D004867:Equipment Design; D004954:Esthetics; D005146:Facial Asymmetry / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008312:Malocclusion, Angle Class II / Q000601:surgery; D008334:Mandible / Q000503:physiopathology / Q000601:surgery; D008336:Mandibular Diseases / Q000601:surgery*; D009068:Movement; D019857:Osteogenesis, Distraction / Q000295:instrumentation / Q000379:methods*; D013524:Surgical Flaps; D013703:Temporal Muscle / Q000637:transplantation; D013705:Temporomandibular Joint Disorders / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome