Albert Dyna, Muthusekhar M R
Department of Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India.
Ann Maxillofac Surg. 2021 Jul-Dec;11(2):298-305. doi: 10.4103/ams.ams_208_20. Epub 2022 Feb 1.
The three commonly employed sequences of distraction osteogenesis (DO) in the management of temporomandibular joint (TMJ) ankylosis with dentofacial deformities include post-arthroplastic distraction osteogenesis (PAD), simultaneous arthroplastic distraction osteogenesis (SAD), and pre-arthroplastic distraction osteogenesis (PrAD).
The aim of this systematic review is to compare the effectiveness of various sequences of DO in the management of TMJ ankylosis with micrognathia/and obstructive sleep apnea syndrome (OSAS).
A comprehensive online and manual search of English language literature with no date restrictions was done on March 2020.
Inclusion criteria were case series and prospective and retrospective studies involving adult/paediatric human subjects with unilateral/bilateral TMJ ankylosis and micrognathia/OSAS treated with DO.
Of 73 studies identified, only 10 were included in the qualitative synthesis. The outcomes assessed were as follows: maximum mouth opening (MMO), posterior airway space (PAS), polysomnography variables, reankylosis, mandibular length, and chin and mandible position.
All the included studies showed high risk of bias. MMO and mandibular length increased, chin and mandibular position improved by the end of treatment in all the three sequences, and polysomnography variables and PAS significantly improved in PrAD compared to PAD and improved in SAD compared to baseline. Reankylosis was significantly less in PrAD.
More well-designed studies comparing the three sequences of DO should be carried out to arrive at a consensus.
在治疗伴有牙颌面畸形的颞下颌关节强直时，常用的三种牵张成骨（DO）序列包括关节成形术后牵张成骨（PAD）、同期关节成形牵张成骨（SAD）和关节成形术前牵张成骨（PrAD）。
本系统评价的目的是比较不同DO序列在治疗伴有小下颌/和阻塞性睡眠呼吸暂停综合征（OSAS）的颞下颌关节强直中的有效性。
2020年3月对无日期限制的英文文献进行了全面的在线和手动检索。
纳入标准为病例系列以及涉及接受DO治疗的单侧/双侧颞下颌关节强直和小下颌/OSAS的成人/儿童受试者的前瞻性和回顾性研究。
在检索到的73项研究中，只有10项纳入了定性综合分析。评估的结果如下：最大开口度（MMO）、后气道间隙（PAS）、多导睡眠图变量、再强直、下颌长度以及颏部和下颌位置。
所有纳入研究均显示存在高偏倚风险。在所有三种序列中，治疗结束时MMO和下颌长度增加，颏部和下颌位置改善，与PAD相比，PrAD中的多导睡眠图变量和PAS显著改善，与基线相比，SAD中的多导睡眠图变量和PAS也有所改善。PrAD中的再强直明显较少。
应开展更多设计良好的研究来比较DO的三种序列，以达成共识。
