Journal article
Protection of the Temporomandibular Joint during Syndromic Neonatal Mandibular Distraction using Condylar Unloading
Plastic and reconstructive surgery (1963), Vol.129(5), pp.1151-1161
2012
DOI: 10.1097/PRS.0b013e31824a2d00
PMID: 22261563
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. © 2012 by the American Society of Plastic Surgeons.
Details
- Title: Subtitle
- Protection of the Temporomandibular Joint during Syndromic Neonatal Mandibular Distraction using Condylar Unloading
- Creators
- Kenneth Fan - University of California, Los AngelesBrian T Andrews - Division of Plastic and Reconstructive Surgery, David Geffen School of Medicine, United StatesEileen Liao - Division of Plastic and Reconstructive Surgery, David Geffen School of Medicine, United StatesKaram Allam - Division of Plastic and Reconstructive Surgery, David Geffen School of Medicine, United StatesCesar Augusto RAPOSO DO AMARAL - Division of Plastic and Reconstructive Surgery, David Geffen School of Medicine, United StatesJames P Bradley - Division of Plastic and Reconstructive Surgery, David Geffen School of Medicine, United States
- Resource Type
- Journal article
- Publication Details
- Plastic and reconstructive surgery (1963), Vol.129(5), pp.1151-1161
- DOI
- 10.1097/PRS.0b013e31824a2d00
- PMID
- 22261563
- NLM abbreviation
- Plast Reconstr Surg
- ISSN
- 0032-1052
- eISSN
- 1529-4242
- Publisher
- Lippincott Williams & Wilkins
- Language
- English
- Date published
- 2012
- Academic Unit
- Craniofacial Anomalies Research Center; Neurosurgery; Otolaryngology
- Record Identifier
- 9984366298402771
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