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Custom alloplastic bilateral TMJ reconstruction and distraction osteogenesis in a 6-year-old with OSA secondary to
Manoj Adhikari1, Kanistika Jha2, Sarita Kc1
1Nepalese Army Institute of Health Sciences, College of Medicine, Kathmandu, Nepal.
Introduction And Importance:
Temporomandibular joint (TMJ) ankylosis in children severely impacts mouth opening, orofacial growth, airway space, and overall quality of life. While costochondral grafts (CCG) are the gold standard for end-stage TMJ reconstruction in children, their unpredictable growth poses challenges, including potential overgrowth, undergrowth, resorption, and reankylosis. However, recent reports have suggested the feasibility of alloplastic TMJ in pediatric patients. This case represents one of the youngest patients to undergo alloplastic bilateral TMJ reconstruction for end-stage TMJ disease documented in the literature.
Presentation Of The Case:
A 6-year-old child presented with complaints of 4 mm mouth opening, retrognathic mandible, and snoring for three years. Detailed investigations and examinations diagnosed severe OSA secondary to bilateral TMJ ankylosis. A 15 mm bilateral mandibular angle distraction was performed. After a three-month consolidation period, bilateral custom alloplastic TMJ reconstruction was done. Post-surgery, the maximum interincisal opening improved to 21 mm, and the retrognathic mandible was corrected. OSA resolved completely. The 25 mm mouth opening was maintained one year postoperatively with no complications.
Clinical Discussion:
The primary advantages of alloplastic TMJ prostheses in treating end-stage TMJ disease include improved mouth opening, maintenance of mandibular form and function, enhanced airway space, elimination of donor site morbidity, reduced operating time, decreased risk of reankylosis, facilitation of immediate physiotherapy, avoidance of under- or overgrowth, and restoration of vertical facial dimensions.
Conclusion:
Custom alloplastic TMJ reconstruction can be a viable treatment option for end-stage TMJ disease in very young children, including those six years old or younger.
