Simultaneous maxillomandibular distraction osteogenesis in hemifacial microsomia: Report of 7 cases

Abstract

Introduction: The goal in treating Hemifacial microsomia (HFM) is to improve facial symmetry, allow functional jaw movement, obtain stable occlusion, and achieve patient satisfaction. This study was planned with an aim to assess the outcome of simultaneous maxillomandibular distraction osteogenesis in hemifacial microsomia. Material & methods: Seven patients with hemifacial microsomia were included in this study and demographic data was obtained. Simultaneous maxillo-mandibular distraction was planned for correction of maxillary cant, vertical ramal lengthening and midline, by performing unilateral mandibular osteotomy in ramus and distractor fixation, a Le Fort I osteotomy, with fixation at contralateral zygomatic buttress and intermaxillary elastics. Derriford Appearance Scale was used to measure individual responses to address problems of appearance. Results: 6 males and 1 female, with age range 18-26 years, mean 22.14 were included in the study. Maxillary occlusal cant varied from 4-16 , mean 9.85 and distraction achieved ranged from 12-19 mm, mean 15.57. Preoperatively DAS score ranged from 42-61, mean 51.7 and improved to 10-27, mean 18.4. 100% success was achieved in 5 cases, while other two showed 96% and 99% success. Conclusion: Simultaneous maxillomandibular distraction osteogenesis improves facial esthetics and obviates the need for postoperative orthodontics, minimizing the treatment period.

Treatment of severe micrognathia in an adult with distraction osteogenesis: A case report

“…DO is often performed in children, teenagers, and young adults, who have a high ability for osteogenesis 1,12 . Although DO in adults has been reported, 4,12–17 only two patients were aged >30 years: a 65‐year‐old man with unilateral distraction 16 and a 34‐year‐old man with bilateral mandibular DO using an intraoral tooth‐borne device 4 .…”

“…DO is often performed in children, teenagers, and young adults, who have a high ability for osteogenesis. 1 , 12 Although DO in adults has been reported, 4 , 12 , 13 , 14 , 15 , 16 , 17 only two patients were aged >30 years: a 65‐year‐old man with unilateral distraction 16 and a 34‐year‐old man with bilateral mandibular DO using an intraoral tooth‐borne device. 4 The small number of adult cases might be due to the concern regarding whether sufficient bone would be formed by DO, and because DO is usually performed at a younger age, as treatment for micrognathia begins in childhood.…”

A Qualitative Assessment of Bone Mineral Density in Individuals With Hemifacial Microsomia: A Cone-Beam Computed Tomography Study

“…Unilateral mandibular distraction osteogenesis was introduced to manage patients with HFM and has proved to be one of the recommended methods in HFM therapy (McCarthy, 1994;Cousley and Calvert, 1997;McCarthy et al, 2002). The development of a posterior open bite in association with unilateral mandibular distraction osteogenesis is expected (McCarthy, 1994;Breuning et al, 2004), which is standardly managed by using additional aids such as bite blocks, intermaxillary elastics or/and temporary anchorage devices (TADs) (Breuning et al, 2004;Maheshwari et al, 2011;Mehrotra et al, 2017). Previous studies have concluded that the success rates of TADs are correlated with the quality and density of the cortical bone (Miyawaki at al., 2003;Motoyoshi et al, 2007;Park et al, 2008;Schätzle at al., 2009).…”

Efficacy and versatility of intraoral monoplanar distractors in the correction of extreme mandibular deformities and severe facial asymmetries - A retrospective study

“…[ 5 ] It also produces a simultaneous increase in the bulk of the surrounding soft tissue envelope by the process of “distraction histiogenesis.”[ 6 ] Since locally regenerated native bone is created along with appropriate neuromuscular re-adaptation and stimulation of the deficient functional matrix in the region, results achieved are far superior to those obtained by either skeletal surgery (such as mandibular osteotomy and advancement with or without interpositional grafts)[ 7 ] or soft tissue surgery, done independently or in combination. [ 8 9 10 11 ]…”