Evaluation of Mandibular Growth and Symmetry in Child with Congenital Zygomatic-Coronoid Ankylosis

Abstract

Ankyloses in the area of the temporomandibular joint (TMJ) are mentioned as a potential etiological factor of mandibular growth disorders and facial asymmetry. The aim of this case study was to evaluate the changes in the mandible of a child with zygomatic-coronoid ankylosis during the first five years of life, in which two adhesion release procedures were performed. The adopted symmetrical approach is based on the assumption of symmetry of the structure of the stomatognathic system in relation to the sagittal median plane. However, the assessment of pathological changes in the structure of the skeletal system was performed using an asymmetrical approach. Computed tomography techniques and a system of computer-aided diagnosis (CAD) were used in the case study. During the child’s growth, linear and angular measurements were made thrice (at the age of 16, 25 and 54 months). The degree of asymmetry was estimated in the measurements made on the right and left sides of the three-dimensional mandible. Unilateral congenital hypoplasia of the articular process and zygomatic-coronoid adhesion caused asymmetrical growth of the mandible in the child along with shortening of the mandibular branch and body on the damaged side and a visible difference in the size of the mandibular angles. Removal of the adhesions during surgical procedures made it possible to reduce the asymmetry of the mandible and catch-up growth, although at the age of five, the mandible was still smaller than the mandible in healthy peers. It was shown that the early adhesion release procedures supported by the CAD analysis enabled the restoration of mandibular symmetry.