American Association of Plastic Surgeons

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Condylar position in Pierre Robin sequence before and after mandibular distraction osteogenesis
Anusha Singh, BS, Seija A. Maniskas, BS, Robin T. Wu, BS, Alex T. Wilson, BS, Derek M. Steinbacher, DMD, MD.
Section of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, CT, USA.

PURPOSE:
3D condylar position within the temporomandibular joint (TMJ) in Pierre Robin sequence (RS) patients following mandibular distraction osteogenesis (MDO) has not been well characterized.
METHODS:
A retrospective, cross-sectional analysis of pediatric patients with RS who underwent MDO was performed. Preoperative and postoperative scans were identified, and 3-dimensional computed tomographic data were analyzed in 3-matic (Materialise). Comparative analysis of condylar position was done using the Wilcoxon signed-rank test and paired t-test.
RESULTS:
3D CT scans were identified in 14 RS patients (28 sides). The RS group included 11 males and 3 females (age at surgery, 1.6-46.7 weeks; average age at surgery, 9.4 weeks). Evaluation of rotation of the mandibular condyle relative to a coronal reference plane showed RS patients had significantly decreased horizontal angles following MDO (-7.545, 95% CI -11.13 to -3.41; p < 0.001). In the anteroposterior direction, significant increase in the angle between the condylar process and body of the ramus was noted (14.135, 95% CI 10.71 to 19.59; p < 0.001). Further intragroup analysis in the preoperative and postoperative RS groups showed no difference between left versus right condylar position measurements. No change in incline of the condyle relative to a transverse reference plane (vertical angle) or in angle relative to the ramus in the lateral/medial direction was detected.
CONCLUSIONS:
In RS, condylar position within the TMJ changes following MDO. The lateral/medial poles of the condyle rotate resulting in decreased angulation relative to the coronal plane, and the condylar process itself shifts in relation to the ramus.


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