Micrognathia with temporomandibular joint ankylosis and obstructive sleep apnea treated with mandibular distraction osteogenesis using skeletal anchorage: a case report

Head Face Med. 2017 Nov 10;13(1):20. doi: 10.1186/s13005-017-0150-4.

Abstract

Background: We describe the case of a 16-year-old female patient with micrognathia, temporomandibular joint (TMJ) ankylosis, and obstructive sleep apnea, who was treated with mandibular distraction osteogenesis (DO) combined with sliding genioplasty, using skeletal anchorage.

Case presentation: We first performed interpositional arthroplasty, in which an interposition of fascia temporalis and surrounding fat tissue was inserted into the defect after bilateral condylectomy, increasing the maximum mouth opening from 5.0 to 32.0 mm. Subsequently, orthodontic treatment and advancement of the mandible were carried out by mandibular DO, using miniscrews and miniplates. Finally, sliding genioplasty was performed to bring the tip of the mandible forward. The total amount of mandibular advancement at the menton was 16.0 mm. An improved facial appearance and good occlusion were eventually achieved, and the apnea-hypopnea index decreased from 37.1 to 8.7. There was no obvious bone resorption or pain in the temporomandibular region, limited mouth opening (maximum mouth opening: 33.0 mm), myofascial pain or headache, downward rotation of the mandible, or lateral shift of mandibular position evident at 5 years and 6 months after mandibular DO.

Conclusion: Mandibular DO using skeletal anchorage with intermaxillary elastics is useful for preventing extrusion of the upper and lower anterior teeth, thereby preventing rotation of the mandible. In addition, mandibular DO combined with sliding genioplasty is effective at improving both dentofacial deformities and impaired respiratory function.

Keywords: Mandibular distraction osteogenesis; Micrognathia; Obstructive sleep apnea; Skeletal anchorage; Sliding genioplasty; Temporomandibular joint ankylosis.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Ankylosis / complications
  • Ankylosis / diagnostic imaging
  • Ankylosis / surgery*
  • Cephalometry / methods
  • Female
  • Follow-Up Studies
  • Humans
  • Mandibular Advancement / methods*
  • Micrognathism / complications
  • Micrognathism / diagnostic imaging
  • Micrognathism / surgery*
  • Orthodontic Anchorage Procedures / methods
  • Osteogenesis, Distraction / methods*
  • Polysomnography / methods
  • Quality of Life
  • Radiography, Panoramic / methods
  • Risk Assessment
  • Sleep Apnea, Obstructive / complications
  • Sleep Apnea, Obstructive / diagnostic imaging
  • Sleep Apnea, Obstructive / surgery*
  • Temporomandibular Joint Disorders / complications
  • Temporomandibular Joint Disorders / diagnostic imaging
  • Temporomandibular Joint Disorders / surgery*
  • Treatment Outcome

Supplementary concepts

  • Temporomandibular ankylosis