title: Protection of the temporomandibular joint during syndromic neonatal mandibular distraction using condylar unloading.
abstract: BACKGROUND
  Neonatal distraction in severe micrognathia patients may alleviate the need for tracheostomy. The authors' objectives in evaluating syndromic neonatal distraction cases were to: (1) document preoperative temporomandibular joint pathology, (2) compare the incidence of postoperative temporomandibular joint ankylosis, and (3) determine whether "unloading" the condyle tended to prevent temporomandibular joint pathology.
  
  
  METHODS
  Syndromic versus nonsyndromic micrognathic (and normal) patient temporomandibular joint abnormalities were compared preoperatively based on computed tomography scans and incisor opening (n = 110). Patient temporomandibular joint outcomes after neonatal mandibular distraction were compared with regard to ankylosis (n = 59). Condylar-loaded versus condylar-unloaded (with class II intermaxillary elastics) temporomandibular joint outcomes were compared based on imaging and the need for joint reconstruction (n = 25).
  
  
  RESULTS
  Preoperative abnormalities of neonatal temporomandibular joint pathology on computed tomography scans were not significant: syndromic, 15 percent; nonsyndromic, 5.9 percent; and normal joints, 4.2 percent. Syndromic patients had a significantly greater interincisor distance decrease postoperatively (48 percent; p < 0.05) and at 1-year follow-up (28 percent; p < 0.05) compared with nonsyndromic patients. Also, computed tomography scans revealed that 28 percent of syndromic patients developed temporomandibular joint abnormalities, whereas nonsyndromic patients were unchanged. Condylar-loaded patients had worse clinical outcomes compared with condylar-unloaded patients (80 percent versus 7 percent) and required temporomandibular joint reconstruction for bony ankylosis (40 percent versus 0 percent) after distraction.
  
  
  CONCLUSIONS
  Neonatal syndromic, micrognathia patients have increased temporomandibular joint pathology preoperatively and bony ankylosis after distraction but are protected with partial unloading of the condyle during distraction.
  
  
  METHODS
  Risk, II; Therapeutic, III.
authors.affiliation: Los Angeles, Calif.; and Miami, Fla. From the Division of Plastic and Reconstructive Surgery, David Geffen School of Medicine; and the Department of Biostatistics, University of California, Los Angeles.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Fan
authors.forename: Brian T
authors.initials: BT
authors.lastname: Andrews
authors.forename: Eileen
authors.initials: E
authors.lastname: Liao
authors.forename: Karam
authors.initials: K
authors.lastname: Allam
authors.forename: Cesar Augusto
authors.initials: CA
authors.lastname: Raposo Amaral
authors.forename: James P
authors.initials: JP
authors.lastname: Bradley
mesh_terms: D000402:Airway Obstruction / Q000209:etiology; D000844:Ankylosis / Q000209:etiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008335:Mandibular Condyle / Q000000981:diagnostic imaging / Q000601:surgery; D008844:Micrognathism / Q000150:complications / Q000601:surgery*; D019857:Osteogenesis, Distraction / Q000009:adverse effects / Q000379:methods*; D019736:Prostheses and Implants; D011859:Radiography; D013577:Syndrome; D013704:Temporomandibular Joint / Q000002:abnormalities / Q000601:surgery*; D016896:Treatment Outcome