title: Pre-arthroplasty simultaneous maxillomandibular distraction osteogenesis for the correction of post-ankylotic dentofacial deformities.
abstract: The aim of this study was to evaluate the hard and soft tissue changes after pre-arthroplasty simultaneous maxillomandibular distraction osteogenesis for the correction of post-ankylotic dentofacial deformities. This prospective study included 10 patients with unilateral temporomandibular joint (TMJ) ankylosis who presented with a facial deformity and a maxillary cant. Informed patient consent was obtained for participation. Simultaneous maxillomandibular distraction was planned based on clinical and radiographic examinations. A horizontal mandibular osteotomy was performed in the ramus and the distractor device was fixed. A bilateral Le Fort I osteotomy was then performed and a four-hole straight plate was fixed on the contralateral zygomatic buttress to act as a fulcrum. After a latency period of 5 days, the distractor was activated twice daily by 0.5mm until the required vertical lengthening was achieved. Intermaxillary fixation was maintained during the entire distraction period. After a consolidation period of 8-12 weeks, the distractor was removed. The TMJ ankylosis was released and a temporal fascia interpositional arthroplasty was performed as second surgery, along with a genioplasty if needed. All patients were followed up for a period of 12-24 months. A marked improvement in the facial asymmetry was noted in all cases. The occlusal cant and mandibular retrusion improved satisfactorily, and the average postoperative inter-incisal opening was 35.6mm. Pre-arthroplasty simultaneous maxillomandibular distraction offers a good treatment outcome, as it allows improvements in facial aesthetics as well as function.
authors.affiliation: Department of Oral and Maxillofacial Surgery, King George's Medical University, Lucknow, India. Electronic address: divyamehrotra@hotmail.com.
authors.forename: D
authors.initials: D
authors.lastname: Mehrotra
authors.affiliation: Department of Oral and Maxillofacial Surgery, King George's Medical University, Lucknow, India.
authors.forename: K
authors.initials: K
authors.lastname: Vishwakarma
authors.affiliation: Department of Oral and Maxillofacial Surgery, King George's Medical University, Lucknow, India.
authors.forename: A L
authors.initials: AL
authors.lastname: Chellapa
authors.affiliation: Department of Oral and Maxillofacial Surgery, King George's Medical University, Lucknow, India.
authors.forename: N
authors.initials: N
authors.lastname: Mahajan
mesh_terms: D000293:Adolescent; D000328:Adult; D000844:Ankylosis / Q000000981:diagnostic imaging / Q000601:surgery*; D001178:Arthroplasty; D063169:Dentofacial Deformities / Q000000981:diagnostic imaging / Q000601:surgery*; D004955:Esthetics, Dental; D005146:Facial Asymmetry / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008334:Mandible; D019857:Osteogenesis, Distraction / Q000379:methods*; D011446:Prospective Studies; D013705:Temporomandibular Joint Disorders; D055815:Young Adult
keywords: Le Fort I osteotomy; bimaxillary; distraction osteogenesis; facial deformity; maxillomandibular; temporomandibular joint