| Protection of Temporomandibular Joint Problems during Syndromic Neonatal Mandibular Distraction using Condylar unloading. | |
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MedLine Citation:
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PMID: 22261563 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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BACKGROUND:: Neonatal distraction in severe micrognathia patients may alleviate the need for a tracheostomy. Our objectives in evaluating syndromic neonatal distraction cases were to 1) document preoperative temporomandibular (TMJ) pathology, 2) compare incidence of postoperative TMJ ankylosis and 3) determine if 'unloading' the condyle was protective of TMJ pathology. METHODS:: Part I: Syndromic vs nonsyndromic micrognathic (and normal) patient TMJ abnormalities were compared preoperatively based on CT scans and incisor opening(n=110). Part II: Syndromic vs. nonsyndromic patients TMJ outcomes after neonatal mandibular distraction were compared with regard to ankylosis(n=59). Part III: "Condylar-Loaded" vs "Condylar-Unloaded" (with Class II intermaxillary elastics) TMJ outcomes were compared based imaging and need for TMJ reconstruction(n=25). RESULTS:: Part I: Preoperative abnormalities of neonatal TMJ pathology on CT scans was nonsignificant(p=.17): syndromic=15%(9/60), nonsyndromic=5.9%(8/136), and normal=4.2%(1/24) joints. Part II: Syndromic patients had significantly greater inter-incisor distance decrease postoperatively (48%,12/25,p<0.05) and 1 year follow-up (28%,7/25,p<0.05) compared to nonsyndromic. Also, CT scans revealed 28%(7/25) syndromic patients developed TMJ abnormalities while nonsyndromic was unchanged(p<0.05). Part III: 'Condylar-Loaded' patients had worse clinical outcomes compared to 'Condylar-Unloaded'(80%;8/10 vs. 7%;1/15) and required TMJ reconstruction for bony ankylosis (40%,4/10 vs. 0%) after distraction. CONCLUSION:: Neonatal syndromic, micrognathia patients have increased TMJ pathology preoperatively and bony ankylosis post-distraction. In addition, partially unloading the condyle during mandibular distraction led to decreased ankylosis and need for TMJ reconstruction. |
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Authors:
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Kenneth Fan; Brian T Andrews; Eileen Liao; Karam Allam; Cesar Augusto Raposo Amaral; James P Bradley |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2012-1-18 |
Journal Detail:
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Title: Plastic and reconstructive surgery Volume: - ISSN: 1529-4242 ISO Abbreviation: - Publication Date: 2012 Jan |
Date Detail:
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Created Date: 2012-1-20 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 1306050 Medline TA: Plast Reconstr Surg Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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1Division of Plastic and Reconstructive Surgery. David Geffen School of Medicine. Los Angeles, CA 2University of Miami, Miller School of Medicine. Miami, FL 3Department of Biostatistics, UCLA. Los Angeles, CA. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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