Mandibular distraction osteogenesis for mandibular retrognathism caused by malunion of bilateral mandibular condyle fractures in childhood with temporomandibular joint dislocation: a case report
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Untreated mandibular condyle fractures in childhood can result in significant jaw deformities, such as mandibular retrognathism, open bite, and facial asymmetry, which may necessitate surgical intervention in later years. Surgical approaches vary depending on the severity of the condition, including mandibular surgery alone, maxillomandibular surgery, or mandibular distraction osteogenesis (MDO). This report highlights a case involving mandibular retrognathism and open bite with condylar dislocation and malunion caused by untreated pediatric condyle fractures. Key challenges in this case included excessive anterior mandibular movement, irregular morphology of the mandibular ramus caused by malunion from fracture healing, and anteromedial dislocation of both condyles, all of which posed significant surgical complexities. The surgical approach combined Le Fort I osteotomy with MDO to perform maxillary impaction and mandibular advancement, followed by a secondary genioplasty. Notably, the dislocated temporomandibular joints were left untreated. Two years postoperatively, no relapse or recurrence of open bite was observed, and the dislocated condyles showed no positional and morphological changes, reflecting favorable outcomes. To our knowledge, this is the first reported case of orthognathic surgery combined with MDO for bilateral dislocated mandibular condyles, making it a valuable contribution to clinical practice.
Abstract
Untreated mandibular condyle fractures in childhood can result in significant jaw deformities, such as mandibular retrognathism, open bite, and facial asymmetry, which may necessitate surgical intervention in later years. Surgical approaches vary depending on the severity of the condition, including mandibular surgery alone, maxillomandibular surgery, or mandibular distraction osteogenesis (MDO). This report highlights a case involving mandibular retrognathism and open bite with condylar dislocation and malunion caused by untreated pediatric condyle fractures. Key challenges in this case included excessive anterior mandibular movement, irregular morphology of the mandibular ramus caused by malunion from fracture healing, and anteromedial dislocation of both condyles, all of which posed significant surgical complexities. The surgical approach combined Le Fort I osteotomy with MDO to perform maxillary impaction and mandibular advancement, followed by a secondary genioplasty. Notably, the dislocated temporomandibular joints were left untreated. Two years postoperatively, no relapse or recurrence of open bite was observed, and the dislocated condyles showed no positional and morphological changes, reflecting favorable outcomes. To our knowledge, this is the first reported case of orthognathic surgery combined with MDO for bilateral dislocated mandibular condyles, making it a valuable contribution to clinical practice.