Vertical and Horizontal Mandibular Lengthening of the Ramus and Body

The technique addresses the vertical increment of facial height and anteroposterior body lengthening of the mandible by distraction followed by release of an ankylosis. Although the esthetic results are satisfactory, all of the patients in the ankylosis group were in an active growth period during both procedures. The vertical and anteroposterior dimension gained after distraction osteogenesis to lengthen the ramus and the body was predictably stable using the ankylosis to prevent undesirable positional changes or relapse by bony resorption. The current thinking of the three theories of mandibular growth is that the condylar cartilage does have some measure of intrinsic genetic programming but restricted to a capacity for continued cellular proliferation, meaning that cartilage cells are coded and geared to divide and continue to divide but extracondylar factors are needed to sustain this activity. In all of the cases, the lack of mandibular condyle and physiologic muscle function caused by the ankylosis in a growing phase compromised the three-dimensional growth of the affected side. After the functional matrix establishes its new equilibrium, secondary procedures, such as genioplasty, may be considered to correct the remaining bony and soft tissue deficiencies. The longer the patient with TMJ ankylosis waits to seek surgical treatment, the more complicated the three-dimensional deficiencies become, requiring an elaborated orthodontic-surgical plan.