Rehabilitation of Dentofacial Asymmetry Secondary to Unilateral Temporomandibular Joint Ankylosis with Dual Distraction and Fixed Orthodontics - Stability at Three-year Follow-up.

Optimal rehabilitation of asymmetric dentofacial deformity secondary to unilateral temporomandibular joint (TMJ) ankylosis is often a challenge. The purpose of this case series is to present an insight into esthetic, occlusal and functional rehabilitation of two patients with varying degree of asymmetric Class II dentofacial deformities secondary to long-standing unilateral TMJ ankylosis. The patients were treated with one-stage surgical protocol employing simultaneous dual distraction technique along with interpositional arthroplasty. Dual distraction technique entailed the simultaneous use of two distractors which allowed for proper control of proximal condylar segment during the course of distraction and lowering the risk of ankylosis recurrence. Thereafter, comprehensive fixed orthodontic mechanotherapy involving the use of temporary anchorage devices was instituted to align and level the compensated dentition. Post-treatment records showed significant improvements in skeletal disharmony and functional stability with good functional occlusion. At the three-year follow-up, the morphological and functionally acceptable results were reasonably well-maintained, with no signs of relapse. Through the two cases reported here, we would like to highlight that one-stage concurrent arthroplasty and dual distraction technique is a safe, stable, and reliable approach for surgical and functional rehabilitation of an adult asymmetric dentofacial deformity secondary to unilateral TMJ ankylosis. Meticulously executed comprehensive orthodontic manipulations involving use of acrylic bite-blocks, elastic traction, and temporary skeletal anchorage device play a crucial role in enhancing the final occlusal outcomes.

Sequential treatment of unilateral temporo-mandibular joint ankylosis with distraction osteogenesis - a case report.

Temporo-mandibular joint (TMJ) ankylosis is a common cause of acquired mandibular deformity in children and adults. It causes reduced mouth opening and limitation of functional movements resulting in mandibular growth impairment leading to mandibular retrognathism and facial asymmetry. The treatment of TMJ ankylosis is challenging, not only due to the complexities involved and the risk of relapse but also because it requires a high degree of patient cooperation. The treatment may be performed in 1 or 2 phases consisting of the initial release of ankylosis with or without condylar reconstruction, followed by a correction of mandibular hypoplasia and of facial asymmetry by orthognathic surgery. Distraction osteogenesis has been proposed to treat cases with severe deformity due to its inherent advantages of generating new bone and soft tissue. This case report describes the staged treatment of a patient with unilateral TMJ ankylosis. The patient presented with significant facial deformity due to mandibular retrognathism and facial asymmetry as a consequence of impaired growth. The treatment objectives included releasing ankylosis to establish mouth opening, addressing the dentofacial deformity and achieving a normal occlusion. The patient was treated with a combined surgical-orthodontic approach including distraction osteogenesis. The case was treated with a rigid external distractor and CBCT generated facial models were used to plan and execute adjunctive surgeries. The staged treatment approach resulted in a significant improvement of facial aesthetics.

The Use of a Bioadhesive (BioGlue(®)) Secured Conchal Graft and Mandibular Distraction Osteogenesis to Correct Pediatric Facial Asymmetry as Result of Unilateral Temporomandibular Joint Ankylosis.

The rehabilitation of children affected by early traumatic facial deformity is a challenge for both the craniofacial team and the child's family. Although the immediate goals of surgery are to restore both form and function, the psychological needs of the growing child must also be addressed. Early surgery may be required to assist integration of the child into the community and thereby avert both social isolation and stigmatization of the child. Timed correctly, such surgery has the potential to harness the patient's own growth to assist in correction of the deformity and to maintain some of the surgical gains. The use of autogenous tissue rather than nondegradable implants to facilitate craniofacial reconstruction in the growing child avoids some of the concerns associated with permanent implants. These include both their potential to adversely affect growth and to migrate. The purpose of this article is to illustrate how advances in tissue adhesion using protein polymers (BioGlue(®); CryoLife, Inc., Kennesaw, GA) and bone regeneration techniques (distraction osteogenesis) have been used to correct the disfiguring and functional problems associated with unilateral temporomandibular joint ankylosis acquired in early childhood.