Adhikari Manoj, Jha Kanistika, Kc Sarita, Rayamajhi Mallika, Amatya Bishwo Ram, Mahaseth Rajeev Kumar
Nepalese Army Institute of Health Sciences, College of Medicine, Kathmandu, Nepal.
College of Medical Sciences, Bharatpur, Chitwan, Nepal.
Int J Surg Case Rep. 2024 Nov;124:110431. doi: 10.1016/j.ijscr.2024.110431. Epub 2024 Oct 10.
Temporomandibular joint (TMJ) ankylosis in children severely impacts mouth opening, orofacial growth, airway space, and overall quality of life. While costochondral grafts (CCG) are the gold standard for end-stage TMJ reconstruction in children, their unpredictable growth poses challenges, including potential overgrowth, undergrowth, resorption, and reankylosis. However, recent reports have suggested the feasibility of alloplastic TMJ in pediatric patients. This case represents one of the youngest patients to undergo alloplastic bilateral TMJ reconstruction for end-stage TMJ disease documented in the literature.
A 6-year-old child presented with complaints of 4 mm mouth opening, retrognathic mandible, and snoring for three years. Detailed investigations and examinations diagnosed severe OSA secondary to bilateral TMJ ankylosis. A 15 mm bilateral mandibular angle distraction was performed. After a three-month consolidation period, bilateral custom alloplastic TMJ reconstruction was done. Post-surgery, the maximum interincisal opening improved to 21 mm, and the retrognathic mandible was corrected. OSA resolved completely. The 25 mm mouth opening was maintained one year postoperatively with no complications.
The primary advantages of alloplastic TMJ prostheses in treating end-stage TMJ disease include improved mouth opening, maintenance of mandibular form and function, enhanced airway space, elimination of donor site morbidity, reduced operating time, decreased risk of reankylosis, facilitation of immediate physiotherapy, avoidance of under- or overgrowth, and restoration of vertical facial dimensions.
Custom alloplastic TMJ reconstruction can be a viable treatment option for end-stage TMJ disease in very young children, including those six years old or younger.
儿童颞下颌关节（TMJ）强直严重影响张口、口面部生长、气道空间及整体生活质量。虽然肋软骨移植（CCG）是儿童终末期TMJ重建的金标准，但其生长不可预测带来了挑战，包括潜在的过度生长、生长不足、吸收及再强直。然而，近期报告提示了异体材料TMJ在儿科患者中的可行性。该病例是文献记载中接受异体材料双侧TMJ重建治疗终末期TMJ疾病的最年幼患者之一。
一名6岁儿童因张口4毫米、下颌后缩及打鼾三年前来就诊。详细检查诊断为双侧TMJ强直继发严重阻塞性睡眠呼吸暂停（OSA）。进行了双侧下颌角15毫米的牵张成骨。经过三个月的巩固期后，进行了双侧定制异体材料TMJ重建。术后，最大切牙间开口度改善至21毫米，下颌后缩得到纠正。OSA完全缓解。术后一年维持了25毫米的张口度，无并发症。
异体材料TMJ假体治疗终末期TMJ疾病的主要优点包括改善张口度、维持下颌形态和功能、增加气道空间、消除供区并发症、缩短手术时间、降低再强直风险、便于立即进行物理治疗、避免生长不足或过度生长以及恢复面部垂直维度。
定制异体材料TMJ重建对于非常年幼的儿童，包括6岁及以下儿童的终末期TMJ疾病可能是一种可行的治疗选择。
