하악골신연술을 이용한 일측성 악관절강직 및 하악발육부전의 동시 교정

Abstract

Damage of temporomandibular joints in infancy may result in ankylosis and alteration of the mandibular growth. In case of unilateral ankylosis occurring in early childhood, a mandibular hypoplasia of the affected side usually follows. The patients have limitation of mouth opening, poor oral hygiene, facial and mandibular growth disturbances, and rarely, upper airway obstruction in the form of either night snoring or obstruction sleep apnea. The objective of this study is to show the use of distraction osteogenesis in mandibular hypoplasia associated with ankylosis and to present our technique for the treatment of mandibular hypoplasia with unilateral ankylosis in infancy consisting of simultaneous arthroplasty which treats the ankylosis and mandibular distraction and enables to correct the facial asymmetry in the same procedure. Between November 1999 and May 2000, three girl patients (42, 44, and 48 months old) who had mandibular hypoplasia associated with ankylosis were treated with simulatneous arthroplasty and distraction osteogenesis. Two kinds of arthroplasties, consisting of gap arthroplasty for one patient and interpositional arthroplasty using a temporal fascia turn-over flap for the other two patients, were executed and mandibular distraction in all three patients. Mouth-opening exercises began on the first day following the operation. Mandibular distraction began on the fifth day after the operation at a rate of 1 mm per day (0.5 mm twice a day) and continued to achieve a slight overcorrection of deviated chin. From the first day after the operation, an increase in the mouth opening was achieved. The average duration of distraction was 20 days. Average duration of consolidation was 6 weeks. Oral opening increased from 2 to 20 mm in case of the first patient, from 4 to 28 mm in the second patient, and from 5 to 24 mm in the third patient. The follow-up period was from 5 to 12 months (mean 8 months). At the time of final evaluation, oral opening and a more normal facial contour persist. It is believed that mandibular distraction combined with arthroplasty offers a new therapeutic option for the treatment of mandibular hypoplasia associated ankylosis, with minimal morbidity and complications.

본 교실에서는 일측성 악관절강직으로 인한 하악성장부전 환아들을 대상으로, 조기에 강직된 악관절에 대한 관절성형술과, 하악성장부전에 대한 골신연술을 동시에 시행함으로써, 기존의 늑골늑연골이식술에서 나타났던 합병증이나 후유증을 최소화하면서 만족할 만한 성과를 거둘 수 있었다. 이는 악관절강직과 함께 나타나는 하악발육부전에 대한 쉽고 안전한 새로운 치료법으로 생각된다. 하지만 추후 악관절강직의 재발 여부와 신연된 골의 성장 정도에 대한 보다 장기간의 추적관찰이 필요할 것으로 생각된다.