As the boy grew up, his parents had begun noticing a developing asymmetry to his lower face. His mandible was slowly begun deviating to the right side with the right side of the mandible being shorter than the left side. He had slowly begun developing chewing problems and speech problems, which progressively became worse with time.
They took him to a local oral surgeon who ordered an OPG of his jaws. This revealed that the patient had ankylosis of the right temporomandibular joint. The surgeon had referred the patient to Balaji Dental and Craniofacial Hospital in Chennai as it was a specialty center for TMJ ankylosis surgery in India.
Dr SM Balaji examined the patient and formulated a treatment plan, which was explained in detail to the patient’s parents. The patient had an asymmetric mandible because of the long standing ankylosis of the right temporomandibular joint. This would have to be corrected through jaw reconstruction surgery with the use of distractors, but the ankylosis release surgery had to be performed first. They consented for surgery and the patient was scheduled for ankylosis release surgery. Surgery was performed successfully and the TMJ ankylosis was released. The second stage of the treatment plan would be distraction osteogenesis.
The patient had impacted lower left third and lower right second and third molars on presentation at this time. It was explained to the parents that these had to be extracted before performing the distraction osteogenesis surgery for the mandible. Upon consultation with the anesthesiologist, it was decided to induce anesthesia through nasal fiberoptic bronchoscopic intubation as the patient had very minimal mouth opening.
The patient was prepped was surgery and anesthesia was induced through nasal fiberoptic bronchoscopic intubation with a certain degree of difficulty. Once anesthesia was established, the impacted molar teeth were extracted without event. The patient recovered uneventfully from anesthesia.
It was explained to the parents that the extraction sockets had to heal completely with filling in of bony tissue. This bone had to get consolidated fully with normal trabecular architecture as surrounding bone. Once radiographic evidence of this had been confirmed, the patient would be scheduled for distraction osteogenesis surgery. The patient’s parents were in full agreement with the treatment planning and were scheduled to return back to the hospital in approximately six to eight month’s time.