Simultaneous arthroplasty and distraction osteogenesis for the treatment of ankylosis of the temporomandibular joint and secondary mandibular deformities in children.

ABSTRACT

The purpose of this study was to explore the use of simultaneous arthroplasty and distraction osteogenesis in the treatment of children with ankylosis of the temporomandibular joint (TMJ) and secondary mandibular deformities. Between January 2012 and December 2016, 17 children (7 boys and 10 girls, mean (range) age 7 (4-12) years) were treated. Preoperatively, the mean (range) maximal incisal opening was 1.4 (0-5) mm. Distraction osteogenesis was used to elongate the mandibular body or ramus, or both, after the release of ankylosis. Distraction began after five to seven days at a rate of 0.5mm twice daily, and the distractor was removed three to five months after the completion of distraction. The mean (range) follow-up time after removal was 29.6 (16-45) months, and the distance of distraction was 14.4 (10-18) mm. After treatment, all patients had satisfactory outcomes, a good facial profile, alignment of the midline lower incisor, and a level occlusal plane. The mean (range) maximum incisal opening reached 35.7 (31-41) mm. Bone formation across the distraction gap was good. The mean minimum axial area of the airway increased from 61.4mm to 96.4mm (p<0.01). No patients had a recurrence of ankylosis during follow up. Our results suggest that simultaneous arthroplasty and distraction osteogenesis is feasible in this group.