Senior Resident, Department of Oral and Maxillofacial Surgery, King George's Medical University, Lucknow, India.
Professor, Department of Oral & Maxillofacial Surgery, King George Medical University, Lucknow, India.
Oral Surg Oral Med Oral Pathol Oral Radiol. 2021 Mar;131(3):295-303. doi: 10.1016/j.oooo.2020.09.005. Epub 2020 Sep 15.
The aim of our study was to evaluate the success of distraction osteogenesis in temporomandibular joint (TMJ) ankylosis patients with facial deformities at our maxillofacial unit; assess the psychosocial and well-being outcomes of distraction osteogenesis and its impact on oral health; and discriminate the differences in quality of life (QoL) with application of external or internal devices, unilateral or bilateral, linear or multivector, and maxillomandibular or mandibular distraction.
QoL and the Oral Health Impact Profile (OHIP) were prospectively studied in 42 consecutive patients with facial deformities, planned for maxillofacial distraction osteogenesis, using 2 validated questionnaires, the Orthognathic Quality of Life Questionnaire and OHIP-14. Patients who had undergone any previous surgeries were excluded.
Among these patients, 16 were female, 26 male; mean age was 14.98 ± 4.88 years, and all had prearthroplastic distraction. The shortening in the mandible was in the proportion 29:01:12 in the body, ramus, and ramus-body, respectively. Mean QoL scores before and after distraction were 68.52 ± 9.50 and 26.62 ± 3.51; and mean OHIP scores before and after distraction were 33.88 ± 6.26 and 15.36 ± 2.54, a highly significant difference (P < .001) suggesting improvement. Significant improvement was identified on all QoL and OHIP questions after distraction (P < .01). The postdistraction overall mean QoL score among patients with extraoral or intraoral distractor did not have a significant difference (P = .32), but facial appearance in the bilateral distraction group; jaw function and overall well-being in the multivector distraction group; and facial appearance, jaw function, and overall well-being in maxillomandibular distraction group had significant improvements (P < .05).
Distraction osteogenesis considerably improves oral health and health-related QoL in patients with TMJ ankylosis with facial deformities. The use of an external or internal distractor did not make any difference in the QoL; however, bilateral distraction, multivector distraction, and maxillomandibular distraction resulted in better QoL outcomes.
我们研究的目的是评估我院颌面外科颞下颌关节（TMJ）强直伴颜面畸形患者牵引成骨的成功率；评估牵引成骨的社会心理和健康相关生活质量（HRQoL）结果及其对口腔健康的影响；并区分使用外部或内部牵引器、单侧或双侧、线性或多矢量、上下颌或下颌骨牵引时，生活质量（QoL）的差异。
我们前瞻性地研究了 42 例因颌面畸形计划接受颌面牵引成骨术的患者，使用 2 种经过验证的问卷，即正颌质量问卷和 OHIP-14，评估 QoL 和口腔健康影响概况（OHIP）。排除了以前接受过任何手术的患者。
这些患者中，女性 16 例，男性 26 例；平均年龄 14.98±4.88 岁，均为术前牵引。下颌骨缩短的比例分别为体部 29:01:12、升支和体支。牵引前和牵引后的 QoL 评分分别为 68.52±9.50 和 26.62±3.51；OHIP 评分分别为 33.88±6.26 和 15.36±2.54，差异有统计学意义（P<.001），提示改善。牵引后所有 QoL 和 OHIP 问题均有显著改善（P<.01）。口外或口内牵引器患者的牵引后总体 QoL 评分无显著差异（P=.32），但双侧牵引组的面部外观、多矢量牵引组的颌功能和整体健康状况以及上下颌骨牵引组的面部外观、颌功能和整体健康状况均有显著改善（P<.05）。
牵引成骨术可显著改善 TMJ 强直伴颜面畸形患者的口腔健康和与健康相关的 QoL。使用外部或内部牵引器对 QoL 没有影响；然而，双侧牵引、多矢量牵引和上下颌骨牵引可获得更好的 QoL 结果。
