Severe proliferative congenital temporomandibular joint ankylosis: a proposed treatment protocol utilizing distraction osteogenesis.
Severe proliferative congenital temporomandibular joint ankylosis: a proposed treatment protocol utilizing distraction osteogenesis.
复制标题
严重增殖性先天性颞下颌关节强直：提出的利用牵引成骨的治疗方案。
DOI：
10.1097/00001665-200605000-00040
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发表时间：
2006
期刊：
影响因子：
--
通讯作者：
Quinn,PeterD
中科院分区：
文献类型：
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作者：
Bartlett,ScottP;Reid,RussellR;Losee,JosephE;Quinn,PeterD
儿童颞下颌关节强直的经典治疗方法：1）关节松解; 2）关节成形术; 3）重建; 4）术后物理治疗（PT），通常不成功。年轻患者术后物理治疗困难，原因是配合不好。此外，有一个亚组的患者患有难治性先天性增生性骨过程，这是他们的疾病的原因。在这些患者中，牵引成骨（DO）的作用已经确定。我们提出一系列的年轻患者先天性增生性颞下颌关节强直。有些人已经失败的经典治疗。在这种情况下，DO用于扩大下颌骨尺寸和软组织基质。这创造了一个静态的开咬，促进了面部中部的生长，并避免了呼吸道，语言，营养和口腔卫生的损害。为了保持这些目标，随着孩子的成熟，可以重复下颌DO。一旦达到骨骼成熟，DO用于使咬合正常化，并在最终重建和积极的术后PT之前进一步扩张软组织包膜。在7例患者中，使用了该方案。五名患者目前处于生长活跃期，正在接受下颌DO的中期治疗。两名患者已达到骨骼成熟，并完成了明确的关节成形术和重建DO的协议。DO是一个有价值的援助，在治疗问题的儿童与先天性增生性颞下颌关节强直。在最终的关节成形术和重建之前，临时DO可以提供静态开牙合，防止进行性畸形及其相关的功能障碍。
The classical treatment for temporomandibular joint (TMJ) ankylosis in children: 1) joint release; 2) arthroplasty; 3) reconstruction; and 4) postoperative physical therapy (PT), is often unsuccessful. Postoperative physical therapy is difficult in the young patient due to poor cooperation. Moreover, there is a subgroup of patients who have a refractory congenital proliferative bony process that is the cause of their disease. In these patients, a role for distraction osteogenesis (DO) has been defined. We present a series of young patients with congenital proliferative TMJ ankylosis. Some have failed classic treatment. In such cases, DO is used to expand the mandibular size and soft tissue matrix. This creates a static open bite, facilitates mid-facial growth, and avoids compromise of the airway, speech, nutrition, and oral hygiene. To maintain these objectives, mandibular DO may be repeated as the child matures. Once skeletal maturity is reached, DO is used to normalize occlusion and further expand the soft tissue envelope prior to definitive reconstruction and aggressive post-op PT. In seven patients, this protocol has been used. Five patients are currently in the active phase of growth and undergoing interim treatment with mandibular DO. Two patients have reached skeletal maturity and have completed the protocol of DO with definitive arthroplasty and reconstruction. DO is a valuable aid in the treatment of the problematic child with congenital proliferative TMJ ankylosis. Interim DO, prior to definitive arthroplasty and reconstruction, can provide a static open bite that prevents progressive deformity and its associated functional disturbances.