Document Detail


Protection of the temporomandibular joint during syndromic neonatal mandibular distraction using condylar unloading.
MedLine Citation:
PMID:  22261563     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Plastic and reconstructive surgery     Volume:  129     ISSN:  1529-4242     ISO Abbreviation:  Plast. Reconstr. Surg.     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-05-01     Completed Date:  2012-06-25     Revised Date:  2012-09-10    
Medline Journal Info:
Nlm Unique ID:  1306050     Medline TA:  Plast Reconstr Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1151-61     Citation Subset:  AIM; IM    
Affiliation:
Division of Plastic and Reconstructive Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
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MeSH Terms
Descriptor/Qualifier:
Airway Obstruction / 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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