PMC3341763_01
Pre-operative frontal view of the patient.
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F1
The initial clinical examination revealed an obviously hypoplastic mandible with chin receded on the affected side and a class II dental relationship [Figures 1 and 2].
Pre-operative lateral profile of the patient.
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F2
The initial clinical examination revealed an obviously hypoplastic mandible with chin receded on the affected side and a class II dental relationship [Figures 1 and 2].
Pre-operative orthopantomograph showing ankylosis of the left TMJ, prominent left antegonial notch, and impacted molars.
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F3
Radiographic investigations included orthopantomogram [Figure 3], lateral skull [Figure 4], and CT scan [Figure 5].
Pre-operative lateral skull view showing convex profile.
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F4
Radiographic investigations included orthopantomogram [Figure 3], lateral skull [Figure 4], and CT scan [Figure 5].
Coronal CT scan view showing obliteration of left interarticular space of TMJ.
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F5
Radiographic investigations included orthopantomogram [Figure 3], lateral skull [Figure 4], and CT scan [Figure 5].
(a) Intraoperative photograph of placement of left external pin distractor percutaneously. Note the osteotomy cut through vestibular incision. (b) Intraoperative photograph of placement of right external pin distractor percutaneously. Note the osteotomy cut through vestibular incision.
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F6
External pin distractors were placed parallel to the occlusal plane, and the pins were inserted percutaneously [Figures 6a and b].
Extra-oral photograph showing placement of external pin distractors bilaterally.
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F7
The distractors were fixed to the bone, tested by activating them 3 mm, and then returned to a neutral position [Figure 7].
Intraoperative photograph showing bony cuts to release TMJ ankylosis.
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F8
A preauricular incision with a temporal extension was made [Figure 8].
Post-operative view photograph showing increase in the mouth opening after interpositional arthroplasty.
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F9
There was a considerable increase in the mouth opening and change in the lateral and frontal profile of the patient [Figures 9-11] and decreased snoring and tongue falling back during sleep.
Post-operative view photograph showing frontal view of the patient after the completion of distraction osteogenesis and interpositional arthroplasty after 5 months.
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F10
There was a considerable increase in the mouth opening and change in the lateral and frontal profile of the patient [Figures 9-11] and decreased snoring and tongue falling back during sleep.
Post-operative view photograph showing the lateral view of the patient after the completion of distraction osteogenesis and interpositional arthroplasty after 5 months.
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F11
There was a considerable increase in the mouth opening and change in the lateral and frontal profile of the patient [Figures 9-11] and decreased snoring and tongue falling back during sleep.
Post-operative orthopantomograph showing ossification of the callus after distraction and interpositional arthroplasty.
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F12
Postoperative orthopantomogram and lateral skull radiographs revealed ossification of the callus and marked improvement in the lateral profile [Figures 12 and 13].
Pre- and post-operative lateral skull view showing considerable improvement in the profile due to mandibular elongation after 5 months.
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F13
Postoperative orthopantomogram and lateral skull radiographs revealed ossification of the callus and marked improvement in the lateral profile [Figures 12 and 13].