Objective. We sought to evaluate the possibility of distraction osteogenesis as an alternative to conventional bilateral sagittal split osteotomy. Complications (intraoperative, intradistraction, and postdistraction) were evaluated retrospectively. Study design. Seventy consecutive patients (40 males and 30 females, 11.2-37.3 years old; mean, 14.2 years) underwent distraction osteogenesis to lengthen the mandible. The surgical procedure was carried out with the patient under general anesthesia. After the osteotomy was performed, 2 intraoral monodirectional distraction devices were placed on the mandibular cortex in the third molar region. The rate of distraction was 1 mm/day. The different complications encountered during all phases of the distraction procedure were recorded. Results. A total of 28 complications (40%) were recorded. In 10 patients (14.3%), the complications were techniqueor device-related, or both, and occurred early in the learning period. Five patients (7.1%) had infection occur, and 3 patients (4.3%) had prolonged sensory loss in the distribution of the alveolar nerve. Severe complications occurred in 6 patients (8.6%). Rehospitalization was necessary in 5 patients (7.1%), 4 of whom (5.7% of the series) required further surgery under general anesthesia. Conclusion. Distraction osteogenesis can be considered a safe and predictable procedure for lengthening the mandible, with a low incidence of major complications. The infection rate and the incidence of damage to the inferior alveolar nerve (2.1%) are low. Compliance of both patients and parents during the whole treatment period is of the utmost importance.
The purpose of this study was to investigate the possibilities of distraction osteogenesis to correct mandibular hypoplasia. Fourteen young patients (mean age 14.1 years) with a proven resistance to initial, functional orthodontic therapy, were treated by means of bilateral intraoral distractors. The corticotomy was performed in the region of the third molar. The latency time was six days and the stabilization period six weeks. In all cases the planned lengthening of the mandible and class 1 occlusion were achieved. Seven patients required additional elastic band traction to close a mild open-bite directly after active distraction. In the first seven patients, insufficient mobilization at the site of the corticotomy had resulted in a broken distraction rod in two patients and incomplete distraction of the lingual cortex in one patient. Adequate mobilization at the site of the corticotomy prevented these problems in later cases. No permanent sensory disturbances were seen. Twelve patients finished their orthodontic treatment within six months after distraction.
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