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Chen S, Jie B, Yue Z, Zhang Y, Liu D, He Y. Growth Evaluation After Costochondral Graft Combined With Functional Appliance in Children With Temporomandibular Joint Ankylosis. J Craniofac Surg 2024:00001665-990000000-01614. [PMID: 38771188 DOI: 10.1097/scs.0000000000010194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 03/06/2024] [Indexed: 05/22/2024] Open
Abstract
The treatment of temporomandibular joint (TMJ) ankylosis in children is a great challenge for surgeons. Costochondral graft (CCG) is a common method of reconstructing the TMJ in children. However, the growth pattern of CCG is unpredictable. In this study, we introduced a surgical-orthodontic approach and evaluated the growth results of the mandible and maxilla in children with TMJ ankylosis through 3-dimensional computed tomography measurements. A prospective cohort study was conducted on child patients diagnosed as having TMJ ankylosis between September 1, 2018 and June 1, 2020. Computer-aided virtual mandibular position guided the CCG, and removable functional appliance was used after surgery. The maximal incisal opening (MIO), the maxilla height, and the length of mandibular ramus were determined. Paired t test was performed to analyze the differences among various stages. Six patients (3 females, 3 males; aged 6-9 y) were included in this study. MIO was 12.4 mm before surgery and improved to 36.8 mm after 42.8 months' follow-up. Mandible length increased by 5.1 mm in the affected side and by 5.3 mm in the unaffected side, without significant difference. The affected maxilla height increased by 6.7 mm, which was more than 5.0 mm in the unaffected side. In conclusion, continued growth of mandible and maxilla can be achieved through CCG combined with functional appliance treatment for children TMJ ankylosis.
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Affiliation(s)
- Shuo Chen
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology; National Center for Stomatology; National Clinical Research Center for Oral Diseases; National Engineering Research Center of Oral Biomaterials and Digital Medical Devices
| | - Bimeng Jie
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology; National Center for Stomatology; National Clinical Research Center for Oral Diseases; National Engineering Research Center of Oral Biomaterials and Digital Medical Devices
| | - Zhihao Yue
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology; National Center for Stomatology; National Clinical Research Center for Oral Diseases; National Engineering Research Center of Oral Biomaterials and Digital Medical Devices
| | - Yi Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology; National Center for Stomatology; National Clinical Research Center for Oral Diseases; National Engineering Research Center of Oral Biomaterials and Digital Medical Devices
| | - Dawei Liu
- Department of Orthodontics, Peking University School and Hospital of Stomatology; National Center for Stomatology; National Clinical Research Center for Oral Diseases; National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, PR China
| | - Yang He
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology; National Center for Stomatology; National Clinical Research Center for Oral Diseases; National Engineering Research Center of Oral Biomaterials and Digital Medical Devices
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Zhang X, Huang D, Lu C, Zhao J, Yang C, He D. Analysis of the effect on costochondral graft for TMJ ankylosis with jaw deformities in pediatrics. Clin Oral Investig 2024; 28:317. [PMID: 38750335 DOI: 10.1007/s00784-024-05708-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 05/06/2024] [Indexed: 07/03/2024]
Abstract
OBJECTIVES To evaluate the effects of costochondral grafting (CCG) used for temporomandibular joint ankylosis (TMJA) in growing patients. MATERIALS AND METHODS Pediatric patients with TMJA treated by CCG from 2010.5 to 2021.7 were included in the study. CT scans were performed before and after operations with at least 1 year follow-up. The height of the mandibular ramus, menton deviation or retraction, osteotomy gap, etc. were measured by ProPlan CMF1.4 software. CCG growth, resorption, and relapse were evaluated and analyzed with influencing factors such as age, ostectomy gap, etc. by generalized estimating equation. RESULTS There were 24 patients (29 joints) with an average age of 6.30 ± 3.13 years in the study. After operation, the mandibular ramus was elongated by 5.97 ± 3.53 mm. Mandibular deviation or retrusion was corrected by 4.82 ± 2.84 mm and 3.76 ± 2.97 mm respectively. After a mean follow-up of 38.91 ± 29.20 months, 58.62% CCG grew (4.18 ± 7.70 mm), 20.69% absorbed (2.23 ± 1.16 mm), and 20.69% re-ankylosed. The re-ankylosis was negatively correlated with the osteotomy gap (OR:0.348,0.172-0.702 95%CI, critical value = 6.10 mm). CCG resorption was positively correlated with the distance of CCG ramus elongation (OR:3.353,1.173-9.586 95%CI, critical value = 7.40 mm). CONCLUSIONS An adequate osteotomy gap and CCG ramus elongation distance are the key factors for successful treatment of TMJA with jaw deformities in growing patients. CLINICAL RELEVANCE TMJA affects mouth opening and jaw development in pediatric patients. The most common autogenous bone graft for pediatric patients is CCG due to its growth potential, convenient access and easy contouring. Also, it can simultaneously reconstruct the TMJ and improve jaw deformity by lengthening the mandibular ramus. But the growth of CCG is unpredictable. In this study, we explored several factors that may affect the absorption and re-ankylosis of CCG, expecting to provide several suggestions to improve future CCG treatment.
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Grants
- JYJC202203, JYHJB202304, 2023-03 Cross-disciplinary Research Fund, Rare diseases registration project, Fund of Department of Oral and Maxillofacial Surgery of Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine
- JYJC202203, JYHJB202304, 2023-03 Cross-disciplinary Research Fund, Rare diseases registration project, Fund of Department of Oral and Maxillofacial Surgery of Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine
- 2022ZZ01017 Shanghai's Top Priority Research Center
- CIFMS, 2019-I2M-5-037 CAMS Innovation Fund for Medical Sciences
- 32071313, 82270996 National Natural Science Foundation of China
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Affiliation(s)
- Xiaoli Zhang
- Department of Oral Surgery, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center of Stomatology, Shanghai, 200011, China
| | - Dong Huang
- Department of Oral Surgery, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center of Stomatology, Shanghai, 200011, China
| | - Chuan Lu
- Department of Oral Surgery, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center of Stomatology, Shanghai, 200011, China
| | - Jieyun Zhao
- Department of Oral Surgery, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center of Stomatology, Shanghai, 200011, China
| | - Chi Yang
- Department of Oral Surgery, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center of Stomatology, Shanghai, 200011, China.
| | - Dongmei He
- Department of Oral Surgery, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center of Stomatology, Shanghai, 200011, China.
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Huang D, Zou L, Lu C, Zhao J, He D, Yang C. Simultaneous standard total joint prosthesis reconstruction with SSRO and Le Fort I osteotomy in the treatment of unilateral temporomandibular joint ankylosis with jaw deformity: a case cohort study. Clin Oral Investig 2024; 28:163. [PMID: 38383876 PMCID: PMC10881754 DOI: 10.1007/s00784-024-05543-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 02/03/2024] [Indexed: 02/23/2024]
Abstract
OBJECTIVE Unilateral temporomandibular joint ankylosis with jaw deformity (UTMJAJD) may require simultaneous total joint prosthesis (TJP) reconstruction, sagittal split ramus (SSRO), and Le Fort I osteotomies. The purpose of this study was to evaluate outcomes in patients treated with these procedures. METHODS Patients diagnosed UTMJAJD between 2016 and 2018 were selected for the study. Mandible-first procedure was performed after ankylosis release with TJP on the ankylosed side and SSRO on the contralateral side. Le Fort I osteotomy with and without genioplasty was lastly performed. Maximal incisor opening (MIO), facial symmetry, and jaw and condyle stability were compared before, after operation, and during follow-ups. RESULTS Seven patients were included in the study. Their average chin deviation was 9.5 ± 4.2 mm, and maxillary cant was 5.1 ± 3.0°. After operation, jaw deformity significantly improved, with chin deviation corrected 7.6 ± 4.1 mm (p = 0.015) and advanced 5.9 ± 2.5 mm (p = 0.006). After an average follow-up of 26.6 ± 17.1 months, MIO significantly increased from 11.4 ± 9.3 to 35.7 ± 2.6 mm (p = 0.000). The occlusion was stable with no significant positional or rotational changes of the jaw (p > 0.05). There was no obvious condylar resorption during follow-ups. CONCLUSION Simultaneous TJP reconstruction, SSRO, and Le Fort I osteotomy are reliable and effective methods for the treatment of UTMJAJD.
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Affiliation(s)
- Dong Huang
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, Shanghai, 200011, China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, 200011, China
| | - Luxiang Zou
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, Shanghai, 200011, China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, 200011, China
| | - Chuan Lu
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, Shanghai, 200011, China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, 200011, China
| | - Jieyun Zhao
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, Shanghai, 200011, China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, 200011, China
| | - Dongmei He
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, Shanghai, 200011, China.
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, 200011, China.
| | - Chi Yang
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, Shanghai, 200011, China.
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, 200011, China.
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Ma W, Niu S, Wang L, Peng C, Fu S, Zhang C, Cui Q, Wang S, Li M, Xu Y. Clinical Application of Individualized 3D-Printed Templates in the Treatment of Condylar Osteochondroma. Healthcare (Basel) 2022; 10:2163. [PMID: 36360504 PMCID: PMC9690499 DOI: 10.3390/healthcare10112163] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Osteochondroma (OC) is one of the most common benign tumors of the long bones, but it rarely occurs in the maxillofacial skeleton. However, mandibular condylar OC often leads to severe facial deformity in affected patients, including facial asymmetry, deviation of the chin, and malocclusion. This study aimed to explore the clinical application of individualized 3D-printed templates to accurately and effectively treat condylar OC. METHODS A total of 8 patients with mandibular condylar OC were treated from July 2015 to August 2021. The enrolled patients (5 women and 3 men) had a median age of 27 years (range: 21-32 years). All patients exhibited symptoms of facial asymmetry and occlusal disorders preoperatively. The digital software used to virtually design the process consisted of three-dimensional reconstruction, 3D-cephalometry analysis, virtual surgery, individualized templates, and postoperative facial soft-tissue prediction. A set of 3D-printed templates (DOS and DOT) were used in all cases to stabilize the occlusion and guide the osteotomy. Then, pre- and post-operative complications, mouth opening, clinical signs, and the accuracy of the CT imaging analysis were all evaluated. All the measurement data were presented as means ± SD; Bonferroni and Tamhane T2 multiple comparison tests were used to examine the differences between the groups. RESULTS All patients healed uneventfully. None of the patients exhibited facial nerve injury at follow-up. In comparing the condylar segments with T0p and T1, the average deviation of the condylar segments was 0.5796 mm, indicating that the post-operative reconstructed condyles showed a high degree of similarity to the reconstruction results of the virtual surgical plan. CONCLUSIONS Individualized 3D-printed templates simplified surgical procedures and improved surgical accuracy, proving to be an effective method for the treatment of patients with slight asymmetric deformities secondary to condylar OC.
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Affiliation(s)
- Wen Ma
- Department of Oral and Maxillofacial Surgery, Kunming Medical University Affiliated Stomatological Hospital, Yunnan Key Laboratory of Stomatology, Kunming 650106, China
| | - Shiwei Niu
- Yunnan Key Laboratory of Stem Cell and Regenerative Medicine, Science and Technology Achievement Incubation Center, Kunming Medical University, Kunming 650500, China
| | - Lidong Wang
- Department of Oral and Maxillofacial Surgery, Kunming Medical University Affiliated Stomatological Hospital, Yunnan Key Laboratory of Stomatology, Kunming 650106, China
| | - Canbang Peng
- Department of Oral and Maxillofacial Surgery, Kunming Medical University Affiliated Stomatological Hospital, Yunnan Key Laboratory of Stomatology, Kunming 650106, China
| | - Shuai Fu
- Department of Oral and Maxillofacial Surgery, Kunming Medical University Affiliated Stomatological Hospital, Yunnan Key Laboratory of Stomatology, Kunming 650106, China
| | - Changbin Zhang
- Department of Oral and Maxillofacial Surgery, Kunming Medical University Affiliated Stomatological Hospital, Yunnan Key Laboratory of Stomatology, Kunming 650106, China
| | - Qingying Cui
- Department of Oral and Maxillofacial Surgery, Kunming Medical University Affiliated Stomatological Hospital, Yunnan Key Laboratory of Stomatology, Kunming 650106, China
| | - Sihang Wang
- Department of Oral and Maxillofacial Surgery, Kunming Medical University Affiliated Stomatological Hospital, Yunnan Key Laboratory of Stomatology, Kunming 650106, China
| | - Ming Li
- Department of Oral and Maxillofacial Surgery, Kunming Medical University Affiliated Stomatological Hospital, Yunnan Key Laboratory of Stomatology, Kunming 650106, China
| | - Yanhua Xu
- Department of Orthodontics, Kunming Medical University Affiliated Stomatological Hospital, Yunnan Key Laboratory of Stomatology, Kunming 650106, China
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Zhao J, He D, Yang C, Lu C, Hu Y, Huang D, Ellis E. 3-D computed tomography measurement of mandibular growth after costochondral grafting in growing children with temporomandibular joint ankylosis and jaw deformity. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 124:333-338. [DOI: 10.1016/j.oooo.2017.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 05/13/2017] [Accepted: 06/01/2017] [Indexed: 11/17/2022]
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Simultaneous treatment of temporomandibular joint ankylosis with severe mandibular deficiency by standard TMJ prosthesis. Sci Rep 2017; 7:45271. [PMID: 28337986 PMCID: PMC5364476 DOI: 10.1038/srep45271] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 02/22/2017] [Indexed: 11/12/2022] Open
Abstract
Temporomandibular joint (TMJ) ankylosis is a refractory disease that is difficult to predictably treat. This study evaluated the prognosis of using standard alloplastic TMJ prostheses for the treatment of TMJ ankylosis in Chinese patients with severe mandibular deficiency. Patients treated from 2013 to 2015 were reviewed. The computer-aided design and manufacture (CAD/CAM) technique was used to guide bony mass removal and locate the TMJ prosthesis (Biomet, USA). Eleven patients were included in this study. All prostheses were successfully installed and stabilized intraoperatively. In 4 patients with severe mandibular deficiency, their mandibular ramus was elongated by the TMJ prosthesis and 2 patients were combined with Le Fort I osteotomy guided by digital templates. Their mean chin advancement was 10.19 mm. Their SNB and ramus heights were also significantly improved after operation (P < 0.05). There was no prosthesis loosening, breakage, or infection leading to removal after a mean follow-up period of 22 months (range, 12-31mos.). Mouth opening was significantly improved from 5.5 mm preoperatively to 31.5 mm postoperatively. TMJ reconstruction with standard alloplastic prosthesis is a reliable treatment for ankylosis, especially in recurrent cases. By CAD/CAM technique, it can correct jaw deformities simultaneously and produce stable results.
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Application of Digital Templates to Guide Total Alloplastic Joint Replacement Surgery With Biomet Standard Replacement System. J Oral Maxillofac Surg 2014; 72:2440-52. [DOI: 10.1016/j.joms.2014.08.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 08/06/2014] [Indexed: 11/17/2022]
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