Technique of Dual Distraction for Correction of Unilateral Temporomandibular Joint Ankylosis With Facial Asymmetry: A Case Series. 2019

Dhirendra Srivastava, and Payal Luthra, and Sonal Mishra, and Lokesh Chandra, and Sarang Sharma, and Harpreet Singh
Dean, Professor, and Head, Department of Oral and Maxillofacial Surgery, ESIC Dental College and Hospital, Rohini, New Delhi, India.

OBJECTIVE Temporomandibular joint (TMJ) ankylosis, not only results in joint hypomobility, but also causes considerable facial deformity. Its unilateral variant can cause facial asymmetry, leading to major psychosocial effects on the individual. METHODS We present the cases of 7 patients with unilateral TMJ ankylosis and facial asymmetry of various grades who have been treated using gap arthroplasty and simultaneous dual distraction. Considerable debate has surrounded the sequencing of TMJ release and distraction osteogenesis; however, the simultaneous approach has recently become popular. The use of a single distractor simultaneously with TMJ release has been widely reported. However, one disadvantage with this technique is that the proximal condylar segment remains unstable. Dual distraction is a newer technique which we have proposed as a single-stage approach for the correction of TMJ ankylosis and facial asymmetry and to address the problems resulting from the use of a single distractor. RESULTS After treatment, all the patients showed a mouth opening ranging from 35 to 50 mm and satisfactory facial symmetry. CONCLUSIONS Dual distraction is a promising technique in the correction of facial asymmetry. However, further studies with adequate statistical analysis and larger sample size are required.

UI MeSH Term Description Entries
D005146 Facial Asymmetry Congenital or acquired asymmetry of the face. Asymmetries, Facial,Asymmetry, Facial,Facial Asymmetries
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000844 Ankylosis Fixation and immobility of a joint. Ankyloses
D001178 Arthroplasty Surgical reconstruction of a joint to relieve pain or restore motion. Bone Tunnel Enlargement,Bone Tunnel Widening,Arthroplasties,Bone Tunnel Enlargements,Bone Tunnel Widenings,Enlargement, Bone Tunnel,Tunnel Enlargement, Bone,Tunnel Widening, Bone,Widening, Bone Tunnel
D013704 Temporomandibular Joint An articulation between the condyle of the mandible and the articular tubercle of the temporal bone. TMJ,Joint, Temporomandibular,Joints, Temporomandibular,Temporomandibular Joints
D013705 Temporomandibular Joint Disorders A variety of conditions affecting the anatomic and functional characteristics of the temporomandibular joint. Factors contributing to the complexity of temporomandibular diseases are its relation to dentition and mastication and the symptomatic effects in other areas which account for referred pain to the joint and the difficulties in applying traditional diagnostic procedures to temporomandibular joint pathology where tissue is rarely obtained and x-rays are often inadequate or nonspecific. Common diseases are developmental abnormalities, trauma, subluxation, luxation, arthritis, and neoplasia. (From Thoma's Oral Pathology, 6th ed, pp577-600) TMJ Disorders,TMJ Diseases,Temporomandibular Disorders,Temporomandibular Joint Diseases,Disease, TMJ,Disease, Temporomandibular Joint,Diseases, TMJ,Diseases, Temporomandibular Joint,Disorder, TMJ,Disorder, Temporomandibular,Disorder, Temporomandibular Joint,Disorders, TMJ,Disorders, Temporomandibular,Disorders, Temporomandibular Joint,Joint Disease, Temporomandibular,Joint Diseases, Temporomandibular,Joint Disorder, Temporomandibular,Joint Disorders, Temporomandibular,TMJ Disease,TMJ Disorder,Temporomandibular Disorder,Temporomandibular Joint Disease,Temporomandibular Joint Disorder
D019857 Osteogenesis, Distraction Bone lengthening by gradual mechanical distraction. An external fixation device produces the distraction across the bone plate. The technique was originally applied to long bones but in recent years the method has been adapted for use with mandibular implants in maxillofacial surgery. Callotasis,Distraction Osteogenesis,Callotases,Distraction Osteogeneses,Osteogeneses, Distraction

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