Restitution of the temporomandibular joint in patients with craniofacial microsomia after multiplanar mandibular distraction: Assessment by magnetic resonance imaging

The purpose of this pilot study was to investigate the response of hypoplastic temporomandibular joints (TMJs) to mandibular distraction osteogenesis. This preliminary study describes changes in 2 male patients with unilateral craniofacial microsomia who were 5 years of age at the time of surgery. Spin echo sequence images of the TMJs without contrast media in axial, coronal, and sagittal views, along with sagittal kinematics studies, were obtained with the use of magnetic resonance imaging (MRI) at: 1 month preoperatively (T1); immediately upon removal of distraction devices (T2), and 14 months postoperatively (T3). At the same time points spiral 3D computed tomography (CT) was used to image the TMJs. Both MRI and CT data obtained were assessed by standard, qualitative interpretation. Predistraction MRI and CT data documented a hemifacial microsomia type IIb deformity with hypoplasia of the condyle and a dysfunctional TMJ on the affected side. After distraction, the MRI and CT data in both patients demonstrated no changes in the nonaffected TMJs. However, on the affected and distracted side the following changes were observed: (1) formation of a rudimentary glenoid fossa and articular eminence; (2) functional displacements of the rudimentary condyle-disk complex; (3) well-defined visualization of the temporalis and lateral pterygoid muscles; (4) increased signal intensity radio-density of the pseudodisk fibrous tissue. Thus, both patients showed improvements in the morphology and function of the TMJ as well as in the associated skeletal and soft tissue components. It was concluded that following mandibular distraction in young children, improved form and function of the TMJ complex is demonstrable using MRI. © 2011.

Duke Scholars

Author Pedro E Santiago Surgery, Plastic, Maxillofacial, and Oral Surgery