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Case Reports
. 2024 Jan 1;20(1):173-179.
doi: 10.5664/jcsm.10856.

Surgical correction of neonatal obstructive sleep apnea due to a temporomandibular joint ankylosis

Michael Pesis  1   2 , Aviv Goldbart  2   3 , Navot Givol  1   2
Affiliations
Case Reports

Surgical correction of neonatal obstructive sleep apnea due to a temporomandibular joint ankylosis

Michael Pesis et al. J Clin Sleep Med. .

Abstract

In growing children, temporomandibular joint (TMJ) ankylosis and septic arthritis are uncommon. Retrognathia and micrognathia affect airway patency and can cause obstructive sleep apnea (OSA). No unified diagnostic criteria have been established for the management of this pathology. We describe the first case of treatment for pediatric TMJ ankylosis and severe OSA due to neonatal group B streptococcal septic TMJ arthritis. Untreated pathological changes in the TMJ will eventually lead to ankylosis. Among children, this will include facial growth disturbances leading to mandibular retrognathia, reduction in the oropharyngeal spaces, and OSA. Our patient had severe OSA with an apnea-hypopnea index of 24.9 events/h and oxygen saturation nadir of 73% as measured by polysomnography. She was treated successfully according to Andrade protocol. This is the first report of pediatric OSA due to TMJ ankylosis following neonatal group B streptococcal septic arthritis.

Citation: Pesis M, Goldbart A, Givol N. Surgical correction of neonatal obstructive sleep apnea due to a temporomandibular joint ankylosis. J Clin Sleep Med. 2024;20(1):173-179.

Keywords: ankylosis; micrognathia; obstructive sleep apnea; retrognathia; septic arthritis; temporomandibular joint.

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Conflict of interest statement

All authors have seen and approved the manuscript. The authors report no conflicts of interest.

Figures

Figure 1
Figure 1. Clinical presentation of maximal interincisal distance (MID) of 4 mm.
Figure 2
Figure 2. Clinical presentation of presurgical facial asymmetry.
Figure 3
Figure 3. A computed tomographic scan of the TMJ (A) in the axial plane and (B) three-dimensional reconstruction.
TMJ = temporomandibular joint.
Figure 4
Figure 4. (A, B) Three-dimensional reconstruction of the upper airway.
Figure 5
Figure 5. Computed tomography scans in the (A) sagittal and (B) coronal aspects revealed severe bony deformation and ankylosis of the temporomandibular joints.
Figure 6
Figure 6. Intraoperative presentation of stage 1 (A) surgical approach and (B) the multivector, monofocal mandibular distractors (Zurich Wood Mandible Distractors, KLS Martin LP, Jacksonville, Florida, USA).
Figure 7
Figure 7. Orthopantomogram (A) and sagittal cephalometry (B) show bone formation at the end of the consolidation period.
Figure 8
Figure 8. Intraoperative presentation of the preauricular approach with Al Kayat-Bramley extension and release TMJ ankyloses.
TMJ = temporomandibular joint.
Figure 9
Figure 9. Bronchoscopy examination.
Figure 10
Figure 10. Presentation of the notable improvements in facial projection.
See this image and copyright information in PMC

References

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