We report the case of a 9-year-old girl from an African country who was referred to our Service via an NGO.
The patient had a limitation of the oral opening of 5 mm due to a casual fall 7 years ago with a bicondylar fracture.
Examination revealed mandibular hypoplasia without occlusion class II with upper and lower compensation and poor oral hygiene with caries.
An orthopantomography and lateral cephalometric teleradiography showed bilateral temporomandibular ankylosis.
The study was completed with a CT scan with 3D reconstruction, taking photographs and evaluation by the Anesthesiology Service.
The social characteristics of the patient prevented the indication of an orthodontic treatment.
1.
The surgical intervention was planned with the consent of the host family.
Nasotracheal intubation was performed with fibr.
We performed a preauricular approach with exposure of the ankylotic block, which was widely resected creating a new glenoid cavity without interposing any material in the space created.
It was completed with a coronoidectomy with bilateral temporal muscle deinsertion.
Then, after an oral opening of 30 mm, we placed an extraoral Molina agent fixed on the arch and prevented distracting surfaces of the ascending mandibular ramus, with the purpose of bloc resection.
The same intervention was performed in the contralateral joint.
1.
After a latency period of 5 days, we started distraction at 1 mm daily and physiotherapy, which involved deactivating the distractor while performing the exercises.
Distraction was completed when a class I was achieved. During the consolidation period, the patient suffered a traffic accident resulting in the detachment of the distractor under general laryngeal anaesthesia that was replaced.
Definitive removal of distractors was performed under local anesthesia 11 weeks after surgery.
The patient was monitored monthly after removal of the distractors, until she had to return to her country 12 months after the intervention, maintaining an oral opening of 30 mm.
Long-term follow-up was not possible.
