[Use of nasal hump as homograft in micrognathism].
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The treatment of the temporomandibular joint ankylosis is a challenge for the oral-facial surgery. In children the ankylosis is often followed by micrognathia and disturbances in the balance of the orofacial system and the whole organism and it makes the problem more serious. All the surgeons who have ever treated ankylosis, had theirs disappointments. The question about the surgical technique and when does it have to be made is still actually. Using the literature we try to represent the most useful techniques for reconstruction of the TMJ and the lower jaw in case of ankylosis and micrognathia We hope to optimize the treatment and to make the life of these patients better.
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The primary manifestations of micrognathia were microglossia, midline fusion of the right and left sides of the mandible, total absence of incisor and molar toothbuds and, in many cases, absence or perhaps premature resorption of Meckel's cartilage. In addition, there was altered osteogenesis as evidenced by disrupted trabecular patterns, as well as an overall dimensional reduction of the mandible both antero-posteriorly and laterally. Strikingly similar results were reported by Johnson (1926), who studied the progeny of x-irradiated mice. How specifically our results correlate with this much earlier work is a matter for further analysis. It seems clear that the critical factor in the development of micrognathia is not so much an abnormal formation of the bony mandible, but a deficiency of tongue development, specifically its intrinsic musculature. Thus, mandibular micrognathia involves not only a dysmorphology of the first branchial arch, but also the mesenchymal cell migration from the occipital somites. Taken together, the picture is one that suggests an underlying cause that may have its inception at a much earlier developmental stage, when ectomesenchymal migration from the region of the neural tube occurs. In any event, we can report confidently that spontaneous micrognathia in prenatal mice is not a simple dimensional reduction of the lower jaw, but a more complex morphological phenomenon.
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