Division of Plastic and Reconstructive Surgery, Department of Surgery, Rush University Medical Center, Chicago, IL.
Section of Oral and Maxillofacial Surgery, Department of Surgery, Michigan Medicine, University of Michigan Medical School, Ann Arbor, MI.
J Craniofac Surg. 2023 Sep 1;34(6):e587-e589. doi: 10.1097/SCS.0000000000009444. Epub 2023 May 29.
Early mandibular distraction osteogenesis (MDO) can decrease upper airway and feeding complications in pediatric patients with micrognathia; however, temporomandibular joint (TMJ) complications like TMJ ankylosis (TMJA) may occur. TMJA can disturb pediatric patients' function and craniofacial growth, resulting in significant physical and psychosocial consequences. Additional surgical procedures may also be required, increasing the burden of care on patients and their families. CMF surgeons must discuss the potential complications of early MDO surgery with families as well as potential solutions should these problems occur. This report presents the case of a 17-year-old male with a severe craniofacial anomaly with features of Treacher-Collins syndrome (TCS) and a surgical history of tracheostomy, cleft palate repair, mandibular reconstruction with harvested costochondral grafts, and MDO with resultant bilateral TMJA and limited mouth opening. The patient Was treated with bilateral custom alloplastic TMJ replacements and simultaneous maxillary DO using a Rigid External Distraction (RED) device.
早期下颌骨牵引成骨术（MDO）可降低小下颌畸形儿童的上呼吸道和喂养并发症；然而，可能会发生颞下颌关节（TMJ）并发症，如 TMJ 强直（TMJA）。TMJA 会干扰儿科患者的功能和颅面生长，导致严重的身体和心理社会后果。可能还需要进行额外的手术，增加患者及其家属的护理负担。CMF 外科医生必须与患者家属讨论早期 MDO 手术的潜在并发症，以及如果出现这些问题的潜在解决方案。本报告介绍了一名 17 岁男性的严重颅面畸形病例，其具有特雷彻-柯林斯综合征（TCS）的特征，并存在气管造口术、腭裂修复、取自体肋软骨移植的下颌骨重建以及导致双侧 TMJA 和张口受限的 MDO 的手术史。该患者接受了双侧定制化全关节 TMJ 置换术和同时使用 Rigid External Distraction（RED）装置的上颌骨 DO 治疗。
