Technique of dual distraction for correction of unilateral temporomandibular joint ankylosis with facial asymmetry: A case report

A Clinical Re-Evaluation of an Unexplored Technique for Post Gap Arthroplasty Retrognathic Mandible

Aims

The current manuscript explores the viability of reverse sagittal split osteotomy technique for correction of ankylotic cases with post gap arthroplasty mandibular retrognathia to achieve socially acceptable esthetic results.

Method

Reverse sagittal split osteotomy which was introduced by Collins et al in 1983 was performed with certain modifications on two cases to correct mandibular hypoplasia in post gap arthroplasty cases. The paper also highlights intraoral as well as extraoral approach for performing the osteotomy along with better management of bad split under direct vision.

Result

It was observed that the reverse sagittal split technique for advancement of mandible in cases of tmj ankylosis-induced dentofacial deformity provided better proximal control, reduced chances of bad split, greater range of advancement (11-14 mm) with esthetically acceptable results. The osteotomy cuts on lateral surface of mandible make the procedure effectively easier and quicker with better control over proximal segment and management under direct vision.

Conclusion

When Distraction Osteogenesis and conventional orthognathic is not a choice in management of dentofacial deformity of post-release ankylosis cases due to the poor proximal control and concern over bad split, reverse sagittal split can be an appropriate choice to manage these deformities without any donor site morbidity.

Technique of Dual Distraction for Correction of Unilateral Temporomandibular Joint Ankylosis With Facial Asymmetry: A Case Series

PURPOSE

Temporomandibular joint (TMJ) ankylosis, not only results in joint hypomobility, but also causes considerable facial deformity. Its unilateral variant can cause facial asymmetry, leading to major psychosocial effects on the individual.

PATIENTS AND METHODS

We present the cases of 7 patients with unilateral TMJ ankylosis and facial asymmetry of various grades who have been treated using gap arthroplasty and simultaneous dual distraction. Considerable debate has surrounded the sequencing of TMJ release and distraction osteogenesis; however, the simultaneous approach has recently become popular. The use of a single distractor simultaneously with TMJ release has been widely reported. However, one disadvantage with this technique is that the proximal condylar segment remains unstable. Dual distraction is a newer technique which we have proposed as a single-stage approach for the correction of TMJ ankylosis and facial asymmetry and to address the problems resulting from the use of a single distractor.

RESULTS

After treatment, all the patients showed a mouth opening ranging from 35 to 50 mm and satisfactory facial symmetry.

CONCLUSIONS

Dual distraction is a promising technique in the correction of facial asymmetry. However, further studies with adequate statistical analysis and larger sample size are required.