Protection of the temporomandibular joint during syndromic neonatal mandibular distraction using condylar unloading.

Abstract

BACKGROUND:

Neonatal distraction in severe micrognathia patients may alleviate the need for tracheostomy. The authors' objectives in evaluating syndromic neonatal distraction cases were to: (1) document preoperative temporomandibular joint pathology, (2) compare the incidence of postoperative temporomandibular joint ankylosis, and (3) determine whether "unloading" the condyle tended to prevent temporomandibular joint pathology.

METHODS:

Syndromic versus nonsyndromic micrognathic (and normal) patient temporomandibular joint abnormalities were compared preoperatively based on computed tomography scans and incisor opening (n = 110). Patient temporomandibular joint outcomes after neonatal mandibular distraction were compared with regard to ankylosis (n = 59). Condylar-loaded versus condylar-unloaded (with class II intermaxillary elastics) temporomandibular joint outcomes were compared based on imaging and the need for joint reconstruction (n = 25).

RESULTS:

Preoperative abnormalities of neonatal temporomandibular joint pathology on computed tomography scans were not significant: syndromic, 15 percent; nonsyndromic, 5.9 percent; and normal joints, 4.2 percent. Syndromic patients had a significantly greater interincisor distance decrease postoperatively (48 percent; p < 0.05) and at 1-year follow-up (28 percent; p < 0.05) compared with nonsyndromic patients. Also, computed tomography scans revealed that 28 percent of syndromic patients developed temporomandibular joint abnormalities, whereas nonsyndromic patients were unchanged. Condylar-loaded patients had worse clinical outcomes compared with condylar-unloaded patients (80 percent versus 7 percent) and required temporomandibular joint reconstruction for bony ankylosis (40 percent versus 0 percent) after distraction.

CONCLUSIONS:

Neonatal syndromic, micrognathia patients have increased temporomandibular joint pathology preoperatively and bony ankylosis after distraction but are protected with partial unloading of the condyle during distraction.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, II; Therapeutic, III.

• Authors: Kenneth Fan, Brian T Andrews, Eileen Liao, Karam Allam, Cesar Augusto Raposo Amaral, James P Bradley
• Journal: Plastic and reconstructive surgery (Plast Reconstr Surg) Vol. 129 Issue 5 Pg. 1151-1161 (May 2012) ISSN: 1529-4242 [Electronic] United States
• PMID: 22261563 (Publication Type: Comparative Study, Journal Article)

Topics

• Airway Obstruction (etiology)
• Ankylosis (etiology)
• Humans
• Infant
• Infant, Newborn
• Mandibular Condyle (diagnostic imaging, surgery)
• Micrognathism (complications, surgery)
• Osteogenesis, Distraction (adverse effects, methods)
• Prostheses and Implants
• Radiography
• Syndrome
• Temporomandibular Joint (abnormalities, surgery)
• Treatment Outcome