Role of extra oral monofocal distractor device in the correction of the facial asymmetry, sleep apnoea, and quality of life associated with TMJ ankylosis

A systematic review on the outcome of distraction osteogenesis in TMJ ankylosis

Introduction

TMJ ankylosis (TMJa) management by arthroplasty alone fails to address the deformity and the compromised airway. Distraction osteogenesis (DO) can offer a pragmatic solution to TMJa. The aim of the study was to generate evidence towards the role of DO in TMJa, evaluate its efficiency and develop an algorithm for use of DO in TMJa.

Material and methods

The research question was formulated using the PICOS statement for reporting guidelines in systematic reviews, where the efficiency of DO was evaluated in terms of mouth opening, correction of facial deformity and asymmetry, airway correction, and its long term effects.

Results

1130 articles reported DO as a treatment modality for TMJ ankylosis, of which 32 prospective studies, 16 retrospective and 2 RCTs were included in the study. DO was used for mandibular distraction in 45 studies and for simultaneous maxillamandibular distraction in only five studies. An algorithm for use of DO in TMJa was developed.

Conclusion

Although DO has proven its application in TMJ ankylosis cases, its best use is for correction of obstructive sleep apnoea. Relapse causing loss of posterior ramal height is a concern after transport DO. Prearthroplastic DO appears to best correct mandibular deformity. A maxillomandibular deformity requires simultaneous maxillomandibular distraction. However, a metanalysis is still awaited for effectiveness of DO in TMJ ankylosis.

Quality of life after distraction osteogenesis in TMJ ankylosis patients

OBJECTIVE

The aim of our study was to evaluate the success of distraction osteogenesis in temporomandibular joint (TMJ) ankylosis patients with facial deformities at our maxillofacial unit; assess the psychosocial and well-being outcomes of distraction osteogenesis and its impact on oral health; and discriminate the differences in quality of life (QoL) with application of external or internal devices, unilateral or bilateral, linear or multivector, and maxillomandibular or mandibular distraction.

STUDY DESIGN

QoL and the Oral Health Impact Profile (OHIP) were prospectively studied in 42 consecutive patients with facial deformities, planned for maxillofacial distraction osteogenesis, using 2 validated questionnaires, the Orthognathic Quality of Life Questionnaire and OHIP-14. Patients who had undergone any previous surgeries were excluded.

RESULTS

Among these patients, 16 were female, 26 male; mean age was 14.98 ± 4.88 years, and all had prearthroplastic distraction. The shortening in the mandible was in the proportion 29:01:12 in the body, ramus, and ramus-body, respectively. Mean QoL scores before and after distraction were 68.52 ± 9.50 and 26.62 ± 3.51; and mean OHIP scores before and after distraction were 33.88 ± 6.26 and 15.36 ± 2.54, a highly significant difference (P < .001) suggesting improvement. Significant improvement was identified on all QoL and OHIP questions after distraction (P < .01). The postdistraction overall mean QoL score among patients with extraoral or intraoral distractor did not have a significant difference (P = .32), but facial appearance in the bilateral distraction group; jaw function and overall well-being in the multivector distraction group; and facial appearance, jaw function, and overall well-being in maxillomandibular distraction group had significant improvements (P < .05).

CONCLUSIONS

Distraction osteogenesis considerably improves oral health and health-related QoL in patients with TMJ ankylosis with facial deformities. The use of an external or internal distractor did not make any difference in the QoL; however, bilateral distraction, multivector distraction, and maxillomandibular distraction resulted in better QoL outcomes.