Distracción mandibular y articulación temporomandibular

Revista Espanola de Cirugia Oral y Maxilofacial 01/2004; DOI: 10.4321/S1130-05582004000400001
Source: OAI

ABSTRACT Los pacientes con deformidades craneofaciales requieren generalmente multiples y, a veces, complejos procedimientos quirurgicos para reconstruir tejidos blandos y duros alterados. Un avance importante en cirugía reconstructiva es el alargamiento de la mandibula por distracción que tiene la ventaja de una cirugía menos agresiva que determinados tipos de osteotomías. Con esta técnica una osteotomía bicortical se hace en distintas zonas de la mandibula colocandose el distractor hasta alcanzar los efectos deseados. Aunque las fuerzas aplicadas se han mostrado eficaces para alargar la mandíbula, sus efectos en segmentos proximales y distales, incluyendo la articulación temporomandibular no han sido analizados sistemáticamente. En este artículo se repasa trabajos experimentales y clínicos en los que se detalla la relación entre distracción mandibular y articulación temporomandibular. Patients with severe craniofacial abnormalities often require multiple and complex surgical procedures to reconstruct maldeveloped hard and soft tissues of the maxillofacial complex. An important advance in reconstructive surgery is mandibular lengthening by gradual distraction, which takes advantage to be less agressive surgery than some osteotomies. With this technique, a bicortical osteotomy is made at the angle of the deficient mandible, and an expansion appliance is placed across the osteotomy line. Although the applied forces have been shown to lengthen the mandible effectively in the region of the application, their effects on the proximal and distal mandibular segments, including the temporomandibular joint region, have not been analyzed systematically. In this article, we study several experimental and clinical papers where it describes the relationship between mandibular distraction and temporomandibular joint.

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    ABSTRACT: The introduction of distraction osteogenesis (DO) as a method of mandibular elongation has provided the craniofacial surgeon with a valuable tool in the approach to patients with mandibular deficiencies. A growing number of case reports and clinical series have proven the efficacy of mandibular DO as an augmentative technique in patients with hemifacial microsomia (HFM). Although DO has become a part of the treatment algorithm for many patients with HFM, surgeons have been reluctant to apply the technique in patients with complete agenesis of the ascending mandibular ramus and condyle (grade III HFM). In the following cases, mandibular DO was successfully performed in two patients with grade III HFM. Preoperative images and intraoperative findings confirmed that both patients lacked the entire ascending mandibular ramus and condyle on the affected side. After unilateral multiplanar DO, both patients showed new bone formation within the distraction gap and development of a pseudoarthrosis between the proximal segment of the mandible and the skull base. Facial symmetry improved dramatically, and speech and mandibular excursion were maintained. The patients have been followed for 1 to 2 years after distraction with durable functional and esthetic outcomes. Mandibular DO offers many advantages compared with rib grafting, including avoidance of donor site morbidity, application in patients who are not candidates for graft harvest, and use after rib graft failure. The following cases support the use of mandibular DO as a mechanism of endogenous tissue engineering in patients with complete agenesis of the ascending mandibular ramus and condyle.
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