Dean A, Alamillos F
Department of Oral and Maxillofacial Surgery of the University Hospital Reina Sofía, Córdoba, Spain.
Plast Reconstr Surg. 1999 Dec;104(7):2021-31. doi: 10.1097/00006534-199912000-00012.
Condylar damage during childhood can produce ankylosis and alteration of the mandibular growth. In case of unilateral ankylosis occurring in early childhood, a mandibular hypoplasia of the affected side may develop. The patients have limitation of mouth opening, facial asymmetry, and chin deviation toward the affected side. The aims of this study are to show the use of distraction osteogenesis in mandibular hypoplasia associated with ankylosis and to present our experience with a new therapeutic option for the treatment of mandibular hypoplasia with unilateral ankylosis in the childhood consisting of the association of arthroplasty to treat the ankylosis and mandibular distraction to correct the facial asymmetry, both accomplished in the same surgical procedure. From November of 1996 to November of 1997, three male patients aged 2, 7, and 13 years with mandibular hypoplasia and ankylosis were treated by distraction osteogenesis. An arthroplasty consisting of the resection of the ankylotic block and interposition of a temporalis muscle flap, plus coronoidectomy was done in two of them and mandibular distraction was done in all three patients. Articular functional rehabilitation began on the first postoperative day. Mandibular distraction began on the fifth postoperative day with a rate of 1 mm per day, ending when the facial symmetry was achieved. From the first postoperative day, an increase in the mouth opening was achieved; this increase continued until ending the distraction. The average duration of distraction was 22 days. Average duration of consolidation was 6 weeks. Oral opening increased from 10 mm to 35 mm in the 7-year-old patient, from 9 mm to 27 mm in the 2-year-old patient, and from 14 mm to 38 mm in the 13-year-old patient. To date, oral opening and facial symmetry persist. Osseous mandibular distraction together with arthroplasty offers an excellent new alternative for treatment of patients with mandibular hypoplasia and associated ankylosis, with minimal morbidity and complications.
儿童期髁突损伤可导致关节强直及下颌骨生长改变。若在幼儿期发生单侧关节强直，患侧下颌骨可能发育不全。患者存在张口受限、面部不对称以及颏部向患侧偏斜。本研究的目的是展示牵张成骨术在下颌骨发育不全伴关节强直中的应用，并介绍我们对于一种新治疗方案的经验，该方案用于治疗儿童单侧关节强直所致的下颌骨发育不全，包括通过关节成形术治疗关节强直以及下颌骨牵张以纠正面部不对称，这两种操作均在同一手术过程中完成。1996年11月至1997年11月，对3例年龄分别为2岁、7岁和13岁的下颌骨发育不全伴关节强直的男性患者进行了牵张成骨术治疗。其中2例患者进行了包括切除关节强直块并植入颞肌瓣以及冠突切除术的关节成形术，3例患者均进行了下颌骨牵张。术后第一天开始进行关节功能康复。术后第五天开始下颌骨牵张，牵张速率为每天1毫米，直至面部对称时结束。从术后第一天起，张口度即有所增加；这种增加一直持续到牵张结束。牵张的平均持续时间为22天。巩固期的平均持续时间为6周。7岁患者的张口度从10毫米增加到35毫米，2岁患者从9毫米增加到27毫米，13岁患者从14毫米增加到38毫米。迄今为止，张口度和面部对称性得以维持。下颌骨牵张成骨术联合关节成形术为治疗下颌骨发育不全伴关节强直的患者提供了一种极佳的新选择，其发病率和并发症极低。
