Chronic Temporomandibular Joint Dislocation by Mandibular Distraction in a Patient With Melnick-Needles Syndrome

Abstract

Melnick-Needles syndrome is a congenital syndrome associated with severe architectural disorder of the skeletal system that can cause significant effects on the craniofacial skeleton including the mandible and temporomandibular joint. We report on a case of a young adult patient who experienced chronic dislocation, pain, and dysfunction of her temporomandibular joints related to both a severe bite dysfunction (mandibular hypoplasia) and the underlying bony architectural disorder associated with Melnick-Needles syndrome. The patient underwent bilateral mandibular distraction to correct her skeletal malocclusion and improve the condylar relationship with the temporomandibular joint fossae. The inherent bony abnormalities presented unique challenges to distraction. The patient was successfully distracted using internal mandibular distractors, rhBMP-2, and a prolonged distraction protocol. The patient experienced complete resolution of symptoms and resumed an unrestricted diet 6 months after removal of devices and has been pain-free for more than 24 months.

Protection of the Temporomandibular Joint during Syndromic Neonatal Mandibular Distraction using Condylar Unloading

“…Despite this reality and suboptimal vector of our elastics, we showed beneficial temporomandibular joint outcomes in our syndromic group of patients. Consistent with other reports, 19,20,35,36 the application of class II intermaxillary elastics alleviated strain and reduced incidence of postoperative pathology from 80 percent in the condylar-loaded compared with 7 percent in the condylar-unloaded patients (Fig. 7).…”

“…18 Another report introduced a Melnick-Needles patient with chronic temporomandibular joint dislocation after bilateral distraction osteogenesis. 19 At our institution, it was noted that select patients with a syndromic diagnosis (Nager, Treacher Collins, Stickler, and other syndromes) developed functional problems, such as decreased mouth opening and poor oral intake following neonatal mandibular distraction. Based on these individual cases and anecdotal events from other reports, 18 -20 we set out to study differences between syndromic and nonsydromic patients with regard to (1) condylar anatomy and pathology and (2) outcomes related to the temporomandibular joint following neonatal mandibular distraction.…”

Caso clínico: aproximación a la vía aérea difícil en neonatología. Síndrome de Treacher-Collins

“…Aunque la correlación exacta entre la patología posoperatoria de la ATM y la edad del paciente sigue siendo debatida, alguna evidencia sugiere que el riesgo de anquilosis de la ATM y otras complicaciones aumenta con la edad. [12][13][14] La característica anatómica única de la vía respiratoria superior de los neonatos, a veces, dificulta la laringoscopía y la intubación. La presencia de anormalidades se suma a esta dificultad.…”

Surgical Management of Craniomaxillofacial Features in the Otopalatodigital Spectrum Disorders

“…Several teams reported their surgical experience in such cases using various techniques. Kelley et al 11 reported the successful performance of bilateral mandibular distraction (with internal mandibular distraction device) to correct the malocclusion of a MNS patient. They added recombinant human bone morphogenetic protein 2 (rhBMP-2) during surgery to help bone healing as MNS is characterized by skeletal dysplasia.…”