Systematic review of current approaches to comprehensive management of children with unilateral mandibular ramus hypoplasia or aplasia in congenital osseous disorders of the temporomandibular joint. Part I: Surgical management

Relevance. Congenital osseous disorders of the temporomandibular joint (TMJ) in children, leading to unilateral hypoplasia and/or aplasia of the mandibular ramus, play a decisive role in the development of skeletal and functional imbalance of the craniofacial complex. Such defects represent a clear indication for surgical intervention. In accordance with established protocols for comprehensive management, the initial stage involves creating a posterior mandibular support, achieved either through distraction osteogenesis (DO) or endoprosthetic replacement of the affected ramus.

Objective. To summarize current knowledge on the classification and pathogenesis of congenital osseous TMJ disorders and to evaluate the outcomes of existing surgical treatment methods in children and adolescents with this condition.

Materials and methods. The literature review was conducted in accordance with PRISMA guidelines for systematic reviews and meta-analyses. Searches were performed in PubMed, Medline, EMBASE, and eLibrary using the keywords “congenital osseous TMJ disorders,” “hemifacial microsomia (HFM),” “surgical treatment in children,” and “distraction osteogenesis (DO),” combined with the Boolean operator AND, in both English and Russian. Original publications proposing classifications of congenital osseous TMJ disorders were also reviewed. Of the 2000 scientific publications identified, 30 met the inclusion criteria and were included in the final analysis.

Results. Both published data and our own clinical observations show that surgical reconstruction of the mandibular ramus in children, while restoring its anatomical structure, does not establish long-term skeletal and functional balance of the dentofacial system due to ongoing growth and development. Consequently, multiple staged surgical procedures are required to maintain craniofacial stability. Yet, the cumulative effect of repeated operations includes progressive scar formation in the soft tissues and worsening mandibular deficiency, which together reduce the adaptive and compensatory capacity of the dentofacial system.

Conclusion. A critical evaluation of surgical outcomes and of the current state of comprehensive management for children with unilateral mandibular ramus hypoplasia or aplasia in congenital osseous TMJ disorders is essential for advancing research and expanding the potential of multidisciplinary rehabilitation for this patient population.

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