| Protection of the temporomandibular joint during syndromic neonatal mandibular distraction using condylar unloading. | |
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MedLine Citation:
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PMID: 22261563 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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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: Comparative Study; Journal Article |
Journal Detail:
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Title: Plastic and reconstructive surgery Volume: 129 ISSN: 1529-4242 ISO Abbreviation: Plast. Reconstr. Surg. Publication Date: 2012 May |
Date Detail:
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Created Date: 2012-05-01 Completed Date: 2012-06-25 Revised Date: 2012-09-10 |
Medline Journal Info:
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Nlm Unique ID: 1306050 Medline TA: Plast Reconstr Surg Country: United States |
Other Details:
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Languages: eng Pagination: 1151-61 Citation Subset: AIM; IM |
Affiliation:
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Division of Plastic and Reconstructive Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Airway Obstruction
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etiology Ankylosis / etiology Humans Infant Infant, Newborn Mandibular Condyle / radiography, surgery Micrognathism / complications, surgery* Osteogenesis, Distraction / adverse effects, methods* Prostheses and Implants Syndrome Temporomandibular Joint / abnormalities, surgery* Treatment Outcome |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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