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Volume 21, Number 1 & 2, March & June 2009

Management of Patients with Obstructive Sleep Apnoea Induced by Temporomandibular Joint Ankylosis: a Novel 2-Stage Surgical Protocol and Report of 5 Cases

Neelam N Andrade, Kanchan R Raikwar
Department of Oral and Maxillofacial Surgery, Nair Hospital and Dental College, Mumbai, India

Abstract
Objectives:
This report introduces a modified surgical technique for the management of patients with temporomandibular joint ankylosis, which induces obstructive sleep apnoea due to micrognathia.
Patients and Methods: Five patients with temporomandibular joint ankylosis with documented polysomnographic obstructive sleep apnoea due to micrognathia were treated using the following modified treatment protocol. Firstly, bilateral mandibular distraction was performed. Following a latency period of 5 days, distraction at the rate of 1 mm per day was done until the posterior airway space was widened. The temporomandibular joint ankylosis was released after a minimum consolidation period of 3 months, with interpositioning of the temporal myofascial flap and removal of the distraction appliances. This was immediately followed by meticulous postoperative jaw exercises.
Results: The results revealed successful mandibular advancement and posterior airway space widening. Postdistraction polysomnography confirmed correction of the obstructive sleep apnoea. After release of the temporomandibular joint, complete patient compliance was achieved for wide mouth-opening exercises with no breathless episodes. Mouth opening has been maintained for a period of 1 year with no relapse.
Conclusion: This report presents a modified surgical protocol for ankylosis release surgery in patients with temporomandibular joint ankylosis that induces obstructive sleep apnoea. This method allows for comfortable active jaw physiotherapy following release of the temporomandibular joint and thereby reduces the chances of reankylosis due to a lack of jaw physiotherapy.


Key words: Ankylosis, Osteogenesis, distraction, Physical therapy modalities, Sleep apnea, obstructive, Temporomandibular joint disorders

Asian J Oral Maxillofac Surg. 2009;21:27-32.
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