الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Ankylosis of the temporomandibular joint represents a complex problem to the patient and the surgeons, which is difficult to treat and requires multidisciplinary approached to solve.
The problem is not only functional but also esthetic in nature.
Temporomandibular joint ankylosis is a caused by trauma in the vast majority of the cases. The earlier the incidence of TMJ ankylosis, the more severe the deformity. Long standing TMJ ankylosis in the pediatric age leads to damage of the condyle and deficiency of the mandibular body and ramus leading to facial asymmetry in unilateral cases and bird face deformity in bilateral cases. The deformity extend to the dentition as teeth can undergo extensive decay and periodontal damage due to inability to perform adequate oral hygiene and inability to deliver proper dental treatment due to the limited mouth opening. Also posterior teeth may be impacted. The deformity will negatively affect the patient interaction with society and the psychological health as well.
Classically, treatment included release of the ankylotic mass and harvesting costochondral graft to reconstruct the ramus condyle unit. Disadvantages of costochondral graft include pain, infection and the uncontrolled and unpredictable growth and the need for a second surgical site.
Distraction osteogenesis has been increasingly popular modality to treat different craniofacial deformity, since the first successful clinical report for mandibular lengthening by distraction osteogenesis reported by McCarthy et al in 1992. The success of distraction osteogenesis concept lead to the evolution of transport condylar distraction osteogenesis to reconstruct mandibular defects. The first clinical use of transport condylar distraction osteogenesis was reported by Stucki-McCormick in 1997. In such technique a transport disc after L osteotomy (or reversed L according to the side) and using a submerged distractor to restore the height of the shortened condyle ramus unit.
In the current work, the correction of TMJ ankylosis and the resultant shortening of the ramus following condylectomy and release has been tried.
In the period from June 2016 and Dec 2018, ten patients with jaw deformity, secondary to the TMJ ankylosis, with deficiency in the ramus-condyle unit admitted to the Maxillofacial and Plastic Surgery Department, Faculty of Dentistry, Alexandria University
Preoperative assessment included clinical and photographic assessment, radiographic evaluation and routine investigations.
All patients were treated under general anesthesia for transport condylar distraction osteogenesis. They were divided into two groups:
The first group (group A):
This group contained five patients. Patients in this group, underwent simultaneous release and distraction at the same operation. This group included four males and one female.
Complications occurred were minor in two patients, moderate in three and major in one case
The second group (group B):
Patients in this group, underwent release followed by distraction osteogenesis as a second stage. This group included four females and one male.
Two patients were free from complications. Moderate in one with two patients developed severe complications.
Our follow up period ranged from 15 months to 60 months to assess the technique and detect any possible complications during different phases of treatment and during the follow-up.
The technique is useful with potential relatively complication rate that must be considered during the treatment plan with counselling with the patient/guardian to explain the plan clearly and to ensure the cooperation during various stages of the treatment.