Combined mandibular distraction osteogenesis and surgical-assisted maxillary rapid expansion to treat patients with severe skeletal Class Ⅱ malocclusion and narrow maxillary dental arch secondary to bilateral idiopathic condylar resorption

doi:10.19438/j.cjoms.2017.02.014

Abstract

Abstract: PURPOSE : To introduce a treatment approach for severe skeletal Class Ⅱ malocclusion and narrow maxillary dental arch secondary to bilateral idiopathic condylar resorption. METHODS : Six cases with severe skeletal Class Ⅱ malocclusion and narrow maxillary dental arch secondary to bilateral ICR were included in this study, and they were treated with mandibular distraction osteogenesis and surgery-assisted rapid maxillary expansion. The path and magnitude of distraction were simulated using computer-aided surgical simulation technique. The outcome of distraction, the necessity of secondary surgery and stability were evaluated through 4 aspects: profile, occlusion, temporomandibular joint (TMJ) condition and sleep respiratory function at T0, T1, T2 and T3. CT, TMJ questionnaire, MRI of TMJ and PSG were acquired at this 4 time points. RESULTS : Three cases finished all treatments. The distraction magnitudes were 13.0mm, 6.7mm and 8.1mm, respectively. Chin advanced in genioplasity for 7.2 mm, 0 and 11 mm, respectively. Maxillary dental arch widened 5.3mm, 7.3 mm and 4.9 mm, respectively. Polysomnography data revealed that severe obstructive sleep apnea hypopnea syndrome was cured. Skeletal malocclusion was effectively corrected in all 3 cases and there was no obvious relapse during remodeling phase. TMJ condition remained stable. CONCLUSION S: Mandibular DO and SARME approach can effectively correct severe skeletal Class II malocclusion and narrow maxillary dental arch secondary to bilateral ICR. Using CASS technology to simulate the magnitude and path of distraction, the outcomes are more stable and predictable.

Key words: Idiopathic condylar resorption, Mandibular distraction osteogenesis, Surgery-assisted rapid maxillary expansion, Computer-aided surgical simulation technique

CLC Number:

R782.2.3

XUE Xiao-chen, LI Biao, SUN Hao, LIU Zhi-xu, ZHU Min, WANG Xu-dong. Combined mandibular distraction osteogenesis and surgical-assisted maxillary rapid expansion to treat patients with severe skeletal Class Ⅱ malocclusion and narrow maxillary dental arch secondary to bilateral idiopathic condylar resorption[J]. China Journal of Oral and Maxillofacial Surgery, 2017, 15(2): 165-170.

References

[1] Handelman CS. Ask us. Condylar resorption[J]. Am J Orthod Dentofacial Orthop, 2004, 125(2): 16A.
[2] Posnick JC, Fantuzzo JJ. Idiopathic condylar resorption: current clinical perspectives[J]. J Oral Maxillofac Surg, 2007, 65(8): 1617-1623.
[3] Mercuri LG. A rationale for total alloplastic temporomandibular joint reconstruction in the management of idiopathic/ progressive condylar resorption[J]. J Oral Maxillofac Surg, 2007, 65(8): 1600-1609.
[4] Papadaki ME, Tayebaty F, Kaban LB, et al. Condylar resorption [J]. Oral Maxillofac Surg Clin North Am, 2007, 19(2): 223-234.
[5] Wolford LM. Concomitant temporomandibular joint and orthognathic surgery[J]. J Oral Maxillofac Surg, 2003, 61(10): 1198-1204.
[6] You MS, Yang HJ, Hwang SJ. Postoperative functional remodeling of preoperative idiopathic condylar resorption: a case report [J]. J Oral Maxillofac Surg, 2011, 69(4): 1056-1063.
[7] Yang HJ, Hwang SJ. Bone mineral density and mandibular advancement as contributing factors for postoperative relapse after orthognathic surgery in patients with preoperative idiopathic condylar resorption/ a prospective study with preliminary 1-year follow-up [J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2015, 120(2): 112-118.
[8] Preston CB. Chronic nasal obstruction and malocclusion [J]. J Dent Assoc S Afr, 1981, 36(11): 759-763.
[9] Moss ML, Salentijn L. The primary role of functional matrices in facial growth [J]. Am J Orthod, 1969, 55(6): 566-577.
[10] D'Ascanio L, Lancione C, Pompa G, et al. Craniofacial growth in children with nasal septum deviation: a cephalometric comparative study[J]. Int J Pediatr Otorhinolaryngol, 2010, 74(10): 1180-1183.
[11] Zettergren-Wijk L, Forsberg CM, Linder-Aronson S. Changes in dentofacial morphology after adeno-/tonsillectomy in young children with obstructive sleep apnoea: a 5-year follow-up study [J]. Eur J Orthod, 2006, 28(4): 319-326.
[12] Kunz F, Linz C, Baunach G, et al. Expansion patterns in surgically assisted rapid maxillary expansion: Transpalatal distractor versus hyrax appliance[J]. J Orofac Orthop, 2016, 77(5): 1-9.
[13] Schendel SA, Tulasne JF, Linck DW 3rd. Idiopathic condylar resorption and micrognathia: the case for distraction osteogenesis [J]. J Oral Maxillofac Surg, 2007, 65(8): 1610-1616.
[14] Van Damme PA, Merkx MA. Condylar resorption in orthognathic surgery [J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 1995, 79(3): 265-266.
[15] Catherine Z, Breton P, Bouletreau P. Condylar resorption after orthognathic surgery: a systematic review[J]. Rev Stomatol Chir Maxillofac Chir Orale, 2016, 117(1): 3-10.
[16] Lee JH, Lee WJ, Shin JM, et al. Three-dimensional assessment of condylar surface changes and remodeling after orthognathic surgery [J]. Imaging Sci Dent, 2016, 46(1): 25-31.
[17] Kobayashi T, Izumi N, Kojima T, et al. Progressive condylar resorption after mandibular advancement [J]. Br J Oral Maxillofac Surg, 2012, 50(2):176-180.
[18] Hwang SJ, Haers PE, Zimmermann A, et al. Surgical risk factors for condylar resorption after orthognathic surgery [J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2000, 89(5): 542-552.
[19] Xia JJ, Gateno J, Teichgraeber JF. Three-dimensional computer-aided surgical simulation for maxillofacial surgery [J]. Atlas Oral Maxillofac Surg Clin North Am, 2005, 13(1): 25-39.
[20] Gateno J, Xia JJ, Teichgraeber JF. New 3-dimensional cephalometric analysis for orthognathic surgery[J]. J Oral Maxillofac Surg, 2011, 69(3): 606-622.
[21] Xia JJ, Gateno J, Teichgraeber JF, et al. Algorithm for planning a double-jaw orthognathic surgery using a computer-aided surgical simulation (CASS) protocol. Part 2: three-dimensional cephalometry [J]. Int J Oral Maxillofac Surg, 2015, 44(12): 1441-1450.
[22] Nie P, Zhu M, Lu XF, et al. Bone-anchored maxillary expansion and bilateral interoral mandibular distraction osteogenesis in adult with severe obstructive sleep apnea syndrome[J]. J Craniofac Surg, 24(3): 949-952.
[23] Xia JJ, Gateno J, Teichgraeber JF, et al. Algorithm for planning a double-jaw orthognathic surgery using a computer-aided surgical simulation (CASS) protocol. Part 1: planning sequence [J]. Int J Oral Maxillofac Surg, 2015, 44(12): 1431-1440.
[24] Sebastiani AM, Baratto-Filho F, Bonotto D, et al. Influence of orthognathic surgery for symptoms of temporomandibular dysfunction [J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2016, 121(2): 119-125.
[25] Calixtre LB, Grüninger BL, Haik MN, et al. Effects of cervical mobilization and exercise on pain, movement and function in subjects with temporomandibular disorders: a single group pre-post test [J]. J Appl Oral Sci, 2016, 24(3):188-197.
[26] Choudhary SH, Kale LM, Mishra SS, et al. An institutional survey for knowledge-based and self-awareness assessment in temporomandibular joint disorders among dental students [J]. Indian J Dent Res, 2016, 27(3): 262-267.
[27] 姜文辉, 王旭东. 外科手术辅助上颌骨快速扩弓的治疗进展 [J]. 口腔颌面外科杂志, 2009, 19(6): 431-435.
[28] Dahiya S, Chitra P, Rao SS, et al. Modified SARME (surgically assisted rapid maxillary expansion) in conjunction with orthodontic treatment: a case report[J]. J Clin Diagn Res, 2015, 9(10): ZD20-22.