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Zurich pediatric distractor for ramal condylar unit distraction in temporomandibular joint ankylosis

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ABSTRACT

Temporomandibular joint (TMJ) Ankylosis is an extremely disabling condition characterized by difficulty or inability to open the mouth resulting in facial asymmetry, malocclusion and dental problems. Surgical excision of the ankylosed mass is the only treatment option available to gain mouth opening. The loss in vertical height of ramus following release of ankylosis is difficult to manage in both unilateral and bilateral TMJ ankylosis. Out of all the methods to restore this height Distraction Osteogenesis (DO) is gaining popularity because of predictable gain in the length without any associated morbidity. Recurrent bilateral TMJ ankylosis in a 32 year old male was treated by osteoarthrectomy and temporal fascia interpositioning arthroplasty. Bilateral reconstruction of ramal condylar unit (RCU) was carried out by Zurich paediatric distractor (KLS Martin, Tuttlingen Germany). Following a latency period of 7 days distraction was carried out at a rate of 1mm/day for 8 days. Distractors were removed after 12 weeks of consolidation period. The case was followed up for 12 months during which the mouth opening was maintained at 38 mm and there was no anterior open bite.

No MeSH data available.


(a) Diagram showing how mandible acts as Class 1 lever. (b) Diagram showing how mandible converts from Class 3 lever to Class 1 lever when the ankylotic mass is removed
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Figure 8: (a) Diagram showing how mandible acts as Class 1 lever. (b) Diagram showing how mandible converts from Class 3 lever to Class 1 lever when the ankylotic mass is removed

Mentions: The anterior open bite is a typical problem seen following the release of bilateral ankylosis. Due to the telescopic effect of residual ramus into glenoid fossae, there is a premature contact of posterior teeth leading to anterior open bite. The clockwise rotation of mandible converts it biomechanically from a Class 3 lever to Class 1 lever in which the points of premature molar contact act as fulcrum. Mandible has the fulcrum at the TMJ, muscles attached to the bone further toward the middle apply the effort and the load is applied through the teeth at the end. Hence, Class 3 lever [Figure 8a]. In cases where the ankylotic mass is released, there is a premature contact of posterior teeth, and it acts as fulcrum. Thus, the conversion from Class 3 to Class 1 lever [Figure 8b].


Zurich pediatric distractor for ramal condylar unit distraction in temporomandibular joint ankylosis
(a) Diagram showing how mandible acts as Class 1 lever. (b) Diagram showing how mandible converts from Class 3 lever to Class 1 lever when the ankylotic mass is removed
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4979324&req=5

Figure 8: (a) Diagram showing how mandible acts as Class 1 lever. (b) Diagram showing how mandible converts from Class 3 lever to Class 1 lever when the ankylotic mass is removed
Mentions: The anterior open bite is a typical problem seen following the release of bilateral ankylosis. Due to the telescopic effect of residual ramus into glenoid fossae, there is a premature contact of posterior teeth leading to anterior open bite. The clockwise rotation of mandible converts it biomechanically from a Class 3 lever to Class 1 lever in which the points of premature molar contact act as fulcrum. Mandible has the fulcrum at the TMJ, muscles attached to the bone further toward the middle apply the effort and the load is applied through the teeth at the end. Hence, Class 3 lever [Figure 8a]. In cases where the ankylotic mass is released, there is a premature contact of posterior teeth, and it acts as fulcrum. Thus, the conversion from Class 3 to Class 1 lever [Figure 8b].

View Article: PubMed Central - PubMed

ABSTRACT

Temporomandibular joint (TMJ) Ankylosis is an extremely disabling condition characterized by difficulty or inability to open the mouth resulting in facial asymmetry, malocclusion and dental problems. Surgical excision of the ankylosed mass is the only treatment option available to gain mouth opening. The loss in vertical height of ramus following release of ankylosis is difficult to manage in both unilateral and bilateral TMJ ankylosis. Out of all the methods to restore this height Distraction Osteogenesis (DO) is gaining popularity because of predictable gain in the length without any associated morbidity. Recurrent bilateral TMJ ankylosis in a 32 year old male was treated by osteoarthrectomy and temporal fascia interpositioning arthroplasty. Bilateral reconstruction of ramal condylar unit (RCU) was carried out by Zurich paediatric distractor (KLS Martin, Tuttlingen Germany). Following a latency period of 7 days distraction was carried out at a rate of 1mm/day for 8 days. Distractors were removed after 12 weeks of consolidation period. The case was followed up for 12 months during which the mouth opening was maintained at 38 mm and there was no anterior open bite.

No MeSH data available.