الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
SUMMARY
The present study conducted to evaluate the efficacy of simultaneous maxilla-mandibular distraction technique in three dimensional correction of facial asymmetry secondary to unilateral TMJ ankylosis. Six adult patients were included in the study. Temporomandibular joint ankylosis was released one year before correction of the deformity
The patients were divided into two groups; group I treated with unidirectional extra-oral device and group II were treated with bidirectional extra-oral device using single osteotomy line. Both groups were evaluated pre-operatively and post-operatively using, standard clinical photographs both intra-oral and extra-oral, study casts, plain radiographs and soft tissue measurements
Skeletal corrections were evaluated in three dimensions including medio-lateral, antro-posterior and vertical dimensions. Soft tissue thickness was evaluated from the lateral cephalometric radiograph. Also, canthal commisure distance was assessed. Data tabulated and statistically analyzed to detect the achieved corrections. There was marked improvement in the vertical height, maxillary length, occlusal canting and facial asymmetry. However, soft tissue correction was limited with incomplete correction of the chin asymmetry. Also, group II patients presented with more significant correction of the facial asymmetry with limited elongation of the facial heights
CONCLUSIONS
1- Simultaneous distraction of mandible and maxilla is the logical treatment for facial asymmetry secondary to unilateral TMJ ankylosis in adult patients. It provides acceptable esthetic results, preserving the pre-operative compensated dental occlusion however; complete correction of asymmetry could not be achieved with this technique.
2- The chin is always medialized by distraction but this does not eliminate the need of sliding genioplasty to improve esthetic results, as was done in one patient.
3- Mandibular retrognathia associated with post ankylotic deformity could not be corrected with unilateral simultaneous maxillo-mandibular distraction technique.
4- Bidirectional distractor presents better correction of post ankylotic deformity than unidirectional distractor.
5- The use of bimaxillary distraction technique in cases presented with contra-lateral maxillary excess resulted in gummy smile and lip incompetence in two cases.