10-yr-old with dentofacial deformity treated successfully

KMC Hospital, Mangalore, has successfully performed a dentofacial deformity correction procedure caused by TMJ (Temporomandibular Joint) Ankylosis via total temporo mandibular joint replacement on a 10-year-old boy. TMJ Ankylosis is nothing but a bony or fibrous adhesion of the anatomic joint components which leads to difficulty in chewing, limitation of mouth opening, trouble related to speech, and oral hygiene. This can also cause asymmetry in the facial skeleton especially when an individual is still in growth phase.

Master Philip (name changed) had a previous history of multiple surgeries following diagnosis of ankylosis with various modalities. For the child, the medical condition had started 10 days postnatal in the form of a parotid abscess and had progressed to the current condition of ankylosis.

The full spectrum of treatment by way of multiple surgeries involved the use of ribs to promote growth in the lower jaw, creating a gap after the removal of bone at the level of joint and interposing muscle to prevent re-fusion. In addition to the above manoeuvres, the child was also subjected to the principles of bone lengthening using distraction osteogenesis, which stems from the principles of orthopaedics by Ilizarov.

Dr. Abhay Kamath Consultant Oral & Maxillofacial Surgery, KMC Hospital, Mangalore, says that the child was diagnosed with MRSA (Methicilin-Resistant Staphylococcus Aureus) during the previous surgeries. MRSA can cause various problems such as bloodstream infections, pneumonia, and surgical site infections which can occur after the surgery is performed on a particular part of the body.

"It was more essential to treat MRSA and plan the surgery, which was a real challenge. After a thorough investigation, the parents were counselled regarding the role and use of Alloplastic Joint Replacement, as the child had exhausted all other treatment modalities. The joints were shipped from Atlanta, Jacksonville, USA, customized for the child, which is referred to as Patient-Specific TMJ Implants," he explains.

"After a thorough preoperative work-up with necessary precaution, which involved expert advice from teams of doctors, the child was subjected to the surgery under general anaesthesia. Post operatively, we were able to achieve a mouth opening of 25mm, compared to the Nil mouth opening. The post-operative period, rehabilitation was a challenging affair and was not a one-person outcome, but involved extensive cooperation from the child and motivation from the parents, in addition to the physiotherapy provided by the department of physiotherapy," he adds.

Dr Anand Venugopal, Regional Chief Clinical Services states "The surgery was the first of its kind to be performed in India. We are happy to declare to have restored the child's mouth opening. The boy is now eating well, attending school, and leading a happy life."