A Triad of Temporomandibular Joint Ankylosis, Mandibular Retrognathia and Severe Obstructive Sleep Apnoea: Case report

Surgical correction of neonatal obstructive sleep apnea due to a temporomandibular joint ankylosis

In growing children, temporomandibular joint (TMJ) ankylosis and septic arthritis are uncommon. Retrognathia and micrognathia affect airway patency and can cause obstructive sleep apnea (OSA). No unified diagnostic criteria have been established for the management of this pathology. We describe the first case of treatment for pediatric TMJ ankylosis and severe OSA due to neonatal group B streptococcal septic TMJ arthritis. Untreated pathological changes in the TMJ will eventually lead to ankylosis. Among children, this will include facial growth disturbances leading to mandibular retrognathia, reduction in the oropharyngeal spaces, and OSA. Our patient had severe OSA with an apnea-hypopnea index of 24.9 events/h and oxygen saturation nadir of 73% as measured by polysomnography. She was treated successfully according to Andrade protocol. This is the first report of pediatric OSA due to TMJ ankylosis following neonatal group B streptococcal septic arthritis.

CITATION

Pesis M, Goldbart A, Givol N. Surgical correction of neonatal obstructive sleep apnea due to a temporomandibular joint ankylosis. J Clin Sleep Med. 2024;20(1):173-179.

Role of distraction osteogenesis and flip genioplasty to correct sleep apnea and aesthetics in long standing TMJ ankylosis - A case report

INTRODUCTION AND IMPORTANCE

Temporomandibular joint (TMJ) ankylosis triad includes TMJ ankylosis, micrognathia, and obstructive sleep apnea (OSA) which is common in long-standing cases of TMJ ankylosis. Unilateral long-standing cases of TMJ ankylosis also result in a severe discrepancy in the midline of the chin.

CASE PRESENTATION

A young adult female presented with restricted mouth opening and daylight sleepiness. Her AHI was mild and there was excessive facial disfigurement. Right-side TMJ ankylosis was diagnosed with compromised posterior airway space and Ramal height was also short on the affected side. Chin has severely deviated to the affected side.

CLINICAL DISCUSSION

Treatment protocols for TMJ ankylosis are different for different case scenarios. A proper protocol derivation is a must looking into the clinical and radiographical examination of the patient. As mentioned in previous literature, anti-Kaban's protocol has been shown to provide good results. A genioplasty improves the chin midline deviation.

CONCLUSION

A careful assessment and a proper treatment plan should be selected for the management and early relief of the symptoms of the patient. Thorough knowledge and update should be available to the operating surgeon to choose the correct treatment plan for the management of a triad patient.

Bilateral temporomandibular joint reconstructions with stock alloplastic prostheses on a distracted mandible - A case report

Background: The management of patients with a triad of temporomandibular joint (TMJ) ankylosis, retrognathia, and obstructive sleep apnea (OSA) has long been a matter of debate. Even though consensus favors distraction osteogenesis (DO) in the 1st phase of treatment to relieve the OSA, various treatment approaches for TMJ reconstruction after ankylosis release have been put forth. Most of the reconstructive modality has been focused on autogenous materials or customized TMJ prostheses after mandibular distraction.Case Presentation: The authors present a case of a patient with the triad of TMJ ankylosis, retrognathia, and OSA who underwent DO for correction of his OSA. This was followed by bilateral TMJ reconstruction with stock alloplastic prostheses on the distracted mandible, along with genioplasty to correct retrogenia.Conclusion: In this case, stock TMJ total joint prostheses were used successfully to treat bilateral TMJ ankylosis following previous surgery for mandibular distraction.