Treatment of Mandibular Deformities Related to TMD by Vertical Ramus Distraction Osteogenesis
To re-establish the dental occlusion, mandibular position and facial appearance, different orthognathic surgical options may be considered. These options include mandibular or bimaxillary surgery or alloplastic joint reconstruction, possibly combined with
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Thomas Klit Pedersen and Sven Erik Nørholt
Abstract
To re-establish the dental occlusion, mandibular position and facial appearance, different orthognathic surgical options may be considered. These options include mandibular or bimaxillary surgery or alloplastic joint reconstruction, possibly combined with maxillary surgery. In cases with moderate deformity and minor malocclusion, an acceptable result can be achieved with orthodontic compensatory treatment combined with chin augmentation. Finally, vertical distraction osteogenesis (DO) with or without maxillary surgery may be considered and will be the focus of this chapter.
14.1 Introduction Inflammation of the temporomandibular joint (TMJ) often gives rise to condylar deformities and structural changes of other joint components such as the disc and fossa. Impaired dentofacial development may therefore occur in growing individuals [1] (Fig. 14.1), and in adults a change in mandibular position may occur over time (Fig. 14.2) [2, 3]. TMJ inflammation can be the result of a local chronic joint disorder and traumatic loading (disc dislocation and degeneration, compression, i.e. idiopathic condylar resorption) [4] or involvement of the TMJ in general arthritic diseases T. K. Pedersen (*) Department of Oral and Maxillofacial Surgery, Aarhus University Hospital and Section of Orthodontics, Aarhus University, Aarhus, Denmark e-mail: [email protected] S. E. Nørholt Department of Oral and Maxillofacial Surgery, Aarhus University Hospital and Section of Oral Surgery and Pathology, Aarhus University, Aarhus, Denmark © Springer Nature Switzerland AG 2019 S. T. Connelly et al. (eds.), Contemporary Management of Temporomandibular Disorders, https://doi.org/10.1007/978-3-319-99909-8_14
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T. K. Pedersen and S. E. Nørholt
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Fig. 14.1 Development of micrognathia from the age of 13–17 in a female with JIA
Fig. 14.2 Change of mandibular position in an adult patient with TMJ arthritis
(rheumatoid arthritis, juvenile idiopathic arthritis) [5, 6]. Some of the patients suffering from these diseases need reconstruction of the mandibular position to enhance occlusion, function and aesthetics. In growing individuals, TMJ inflammation may hamper the growth and development of the condyle and fossa. In most cases, this will result in a short condylar height and decreased ramus length [5, 7, 8]. This affects the posterior face height; and when growth has ceased, the end result is a retrognathic mandible, a steep occlusal plane and various dentoalveolar compensatory or dysplastic changes (Fig. 14.1). An open bite with contact only on the posterior teeth characterises the dental occlusion.
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In nongrowing individuals, progressive condylar degradation can be followed by a change in mandibular position. The mandible rotates clockwise, and, like the growth disturbance described above, an open bite develops, although without the characteristic changes in mandibular morphology (Fig. 14.2). To re-e
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