Mehrotra D, Vishwakarma K, Chellapa A L, Mahajan N
Department of Oral and Maxillofacial Surgery, King George's Medical University, Lucknow, India.
Department of Oral and Maxillofacial Surgery, King George's Medical University, Lucknow, India.
Int J Oral Maxillofac Surg. 2016 Jul;45(7):820-7. doi: 10.1016/j.ijom.2015.10.009. Epub 2016 Jan 15.
The aim of this study was to evaluate the hard and soft tissue changes after pre-arthroplasty simultaneous maxillomandibular distraction osteogenesis for the correction of post-ankylotic dentofacial deformities. This prospective study included 10 patients with unilateral temporomandibular joint (TMJ) ankylosis who presented with a facial deformity and a maxillary cant. Informed patient consent was obtained for participation. Simultaneous maxillomandibular distraction was planned based on clinical and radiographic examinations. A horizontal mandibular osteotomy was performed in the ramus and the distractor device was fixed. A bilateral Le Fort I osteotomy was then performed and a four-hole straight plate was fixed on the contralateral zygomatic buttress to act as a fulcrum. After a latency period of 5 days, the distractor was activated twice daily by 0.5mm until the required vertical lengthening was achieved. Intermaxillary fixation was maintained during the entire distraction period. After a consolidation period of 8-12 weeks, the distractor was removed. The TMJ ankylosis was released and a temporal fascia interpositional arthroplasty was performed as second surgery, along with a genioplasty if needed. All patients were followed up for a period of 12-24 months. A marked improvement in the facial asymmetry was noted in all cases. The occlusal cant and mandibular retrusion improved satisfactorily, and the average postoperative inter-incisal opening was 35.6mm. Pre-arthroplasty simultaneous maxillomandibular distraction offers a good treatment outcome, as it allows improvements in facial aesthetics as well as function.
本研究的目的是评估关节置换术前同期上颌下颌骨牵张成骨术矫正关节强直后牙颌面畸形后的软硬组织变化。这项前瞻性研究纳入了10例单侧颞下颌关节（TMJ）强直且伴有面部畸形和上颌偏斜的患者。获得了患者参与研究的知情同意书。根据临床和影像学检查计划同期上颌下颌骨牵张。在升支处进行水平下颌骨截骨术并固定牵张器装置。然后进行双侧Le Fort I截骨术，并在对侧颧弓支柱上固定一块四孔直板作为支点。在5天的延迟期后，每天两次以0.5mm的速度激活牵张器，直至达到所需的垂直延长量。在整个牵张期保持颌间固定。在8至12周的巩固期后，取出牵张器。松解TMJ强直，作为二期手术进行颞筋膜间置关节成形术，必要时进行颏成形术。所有患者随访12至24个月。所有病例均观察到面部不对称有明显改善。咬合偏斜和下颌后缩得到满意改善，术后平均切牙间开口度为35.6mm。关节置换术前同期上颌下颌骨牵张提供了良好的治疗效果，因为它能改善面部美观和功能。
