Short-term changes in temporomandibular joint function in subjects with cleft lip and palate treated with maxillary distraction osteogenesis

Maximal Mouth Opening in Infants: A Single-Group Prospective Cohort Study

BACKGROUND

Detection of mandibular range of motion variations in infants may allow for early diagnosis of pathologic conditions to the temporomandibular joint.

PURPOSE

The purpose of this study was to determine the normal ranges for maximal mouth opening (MMO) in healthy infants under 12 months of age.

STUDY DESIGN, SETTING, SAMPLE

A single-group prospective cohort study of consecutive patients below 12 months of age was conducted in an outpatient setting at the Florida Craniofacial Institute in Tampa, Florida. Patients were excluded if they had trismus, presented with signs of obstructive sleep apnea, suffered a facial fracture, or were diagnosed with a craniofacial syndrome.

PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE

Age (in months) at the time of presentation, measured as a continuous variable.

MAIN OUTCOME VARIABLE(S)

The main outcome variable was MMO. This was measured by placing a thumb and forefinger in the infant's mouth and applies slight pressure to encourage MMO. In older infants with erupted central incisors, MMO was measured from the gingival margins.

COVARIATES

The covariates were sex, race, and gestational age.

ANALYSES

Findings were presented as means with 95% confidence intervals. A multivariate linear regression analysis was conducted to evaluate changes in MMO with increasing age.

RESULTS

The sample was composed of 151 infants with a mean age of 5.2 months (95% confidence interval [CI] 4.8 to 5.6), and 33% were female. The mean MMO was 32.1 mm (95% CI 31.5 to 32.7). Results of the linear regression analysis showed MMO to significantly increase with increasing age, increasing at a mean rate of approximately 1 mm per month (coefficient 1.06, 95% CI 0.88 to 1.23, P < .001). In neonates <1 month of age, the mean MMO was 22.0 mm (95% CI 20.4 to 23.6), compared to a mean of 36.7 mm (95% CI 34.8 to 38.6) in infants 11 months of age.

CONCLUSIONS AND RELEVANCE

The results of this study provide normative data of the association of age with MMO, which may be of value in assessing for infants with jaw mobility disorders.

Temporomandibular joint dislocation in patients with cleft lip and palate after maxillary distraction osteogenesis: Three case reports

INTRODUCTION

Distraction osteogenesis (DO) is a widely used for cleft and palate related maxillary hypoplasia. There has been little research on temporomandibular joint (TMJ) dislocation after maxillary DO. We present these 3 cases and analyze the possible causes for reference by other clinicians.

PATIENT CONCERNS

In the late stages of maxillary DO, the patients gradually felt a decrease in mandibular mobility and suffered from limited mouth opening. Case 2 and 3 could open their mouth up to 1 and 2 fingers and Case 1 barely able to open her mouth at the completion of distraction.

DIAGNOSIS

Case 1 and Case 3 were diagnosed as right TMJ dislocation and Case 2 had a TMJ dislocation on her left side.

INTERVENTIONS

Patients with TMJ dislocation were repositioned with manipulation as soon as detected.

OUTCOMES

There was no recurrence in all three cases during the postoperative follow-up period.

CONCLUSIONS

Maxillary DO can sufficiently advance the maxilla in cleft lip and palate patients. Clinicians should be mindful of the TMJ dislocations that maxillary DO can exert on patients.