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. 2017 May-Aug;7(2):147-152.
doi: 10.1016/j.jobcr.2017.04.009. Epub 2017 May 7.

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

Divya Mehrotra  1 , Debraj Howladar  1 , Dichen P Bhutia  1
Affiliations

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

Divya Mehrotra et al. J Oral Biol Craniofac Res. 2017 May-Aug.

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.

Keywords: Hemifacial microsomia; Simultaneous maxilla mandibular distraction.

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Figures

Fig. 1
Fig. 1
a. Preoperative, b. mandibular distractor in place, c. Lefort I osteotomy & contralateral fixation, d. post distraction, e. Preoperative PA cephalogram, f. postdistraction PA cephalogram, g. 1 year follow up PA cephalogram.
Fig. 2
Fig. 2
a. Preoperative front view, b. preoperative profile view, c. preoperative 3D CT front view, d. preoperative 3D CT profile view, e. postdistraction front view with mandibular multivector distractor in place, f. postdistraction profile view with distractor in place, g. preoperative occlusion, h. post operative occlusion.
Fig. 3
Fig. 3
a. Preoperative front view, b. preoperative 3D CT front view, c. PA cephalogram with distractor in place, d. medpore onlay implant at angle fixed with screws, e. dermal fat graft, f. genioplasty, g. postdistraction front view.
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