Intraoral mandibular distraction osteogenesis: special attention to treatment planning (original) (raw)
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Bilateral Distraction Osteogenesis for the Management of Mandibular Hypoplasia
2014
Introduction: Patients with mandibular bilateral hypoplasia usually present with varying degrees of facial deformity, upper airway obstruction and difficulty with feeding. Treatment of such cases is very important. Distraction osteogenesis (DO) using intra and extra-oral devices provides an excellent alternative when other surgical techniques do not prove to be satisfactory. Aim of the Work: To evaluate the efficacy of bilateral DO in the treatment of mandibular hypoplasia. Patients and Methods: Ten patients (7 females and 3 males), their ages ranged from 7 years to 23 years (with a mean of 14.45 years). They presented with bilateral mandibular hypoplasia with facial deformity, difficulty in feeding and three of them presented with obstructive sleep apnoea. All patients were treated with bilateral mandibular distraction osteogenesis, using intra and extra-oral unidirectional distractors. The follow-up periods were immediately, 3 months, 6 months and one year post distraction. Result...
A Rare Complication Associated with Distraction Osteogenesis in Correction of Maxillary Hypoplasia
International Dental Research
Aim: Distraction osteogenesis (DO) is an alternative to orthognathic surgery that appears to have some advantages for advancement in the maxilla and mandible, but relatively high complication rates have been reported in the maxillofacial region. Methodology: A 22-year-old female with the chief complaint of maxillary hypoplasia was referred to our clinic. A two-stage procedure combining maxillary advancement by distraction technique with mandibular setback surgery was performed to correct jaw deformity. At the sixth day of the distraction breakage of the device occurred. The distractors were removed and the patient was treated using conventional osteotomy techniques to achieve good occlusion and improve the facial profile Results: Besides there are a number of studies about complications of DO, breakage of distractor has been really rare reported. In our case this unexpected and a very rarely reported complication occurred. Conclusions: The purpose of the present case report is to pr...
Journal of Craniofacial Surgery, 2009
Distraction osteogenesis has become a treatment alternative to treat severe craniofacial skeletal dysplasias. A rigid external distraction device has been successfully used to advance the maxilla as well as the maxillary, orbital, and forehead complex (monobloc) in children as young as 2 years, adolescents, and adults. For this severe group of patients, the technique has been found to be simpler and safer than traditional surgical methods. Maxillary and midfacial advancement through distraction has been found to be extremely stable in the patients in whom the technique was used. The authors introduce an intraoral distractor for those patients requiring a moderate maxillary advancement. The advantages of the device include ease of insertion, vector adjustability, reactivation capabilities, and no need for second procedure for its removal. The above approaches have provided predictable and stable results. A detailed description of the device, necessary orthodontic and surgical procedures, case reports, and cephalometric outcomes are presented. The techniques can be applied alone or as an adjunct to traditional orthognathic and craniofacial surgical procedures.
Stability after distraction osteogenesis to lengthen the mandible: results in 50 patients
Journal of Oral and Maxillofacial Surgery, 2004
The purpose of this study was to investigate mandibular stability after lengthening the mandible by means of distraction. Materials and Methods: Fifty patients (mean age, 14.7 years; range, 11.2 to 37.3 years) with Angle Class II mandibular hypoplasia were treated by bilateral distraction osteogenesis to lengthen the mandible. Patients were divided into a high-angle group, with a high mandibular angle (sella/nasionmandibular plane [SN-MP] Ͼ38°), and a normal-to-low mandibular angle group (SN-MP Յ38°). Clinical measurements and standardized cephalometric radiographs were taken just before operation; postdistraction at time of removal of the distraction devices, and 6 months and 1 year postoperatively. Analysis was performed by means of angle measurements: sella/nasion-maxilla point A (SNA), sella/nasionmandibular point B (SNB), and SN-MP. Results: Eight of 14 high-angle patients showed a degree of relapse (57%), and only 3 of 36 patients showed relapse in the low/normal-angle group (8.3%). Conclusion: It can be concluded that high-angle patients are still at risk of relapsing and that distraction osteogenesis cannot prevent relapse in cases with a high mandibular plane angle. For low-angle patients, however, distraction is a safe and predictable procedure.
Distraction Osteogenesis: Treatment of a Case with Maxillary Hypoplasia and Mandibular Prognatism
International Dental Research
method for treating mandibular prognathism, distraction osteogenesis (DO) of the maxillary complex is an alternative approach. Methodology: The clinical and radiological examinations of a 29-year-old male revealed maxillary retrognathism and mandibular prognathism without a vertical abnormality. The patient was treated with maxillary advancement by DO and mandibular setback surgery. Results: Long-term functional muscle exercises were scheduled. No relapse has occurred. Conclusions: We believe that the patient’s cooperation and commitment to the functional exercise program played the most important role in the long-term success. How to cite this article: Apaydın A, Yenigün S, Can T. Distraction Osteogenesis: Treatment of a Case with Maxillary Hypoplasia and Mandibular Prognatism. Int Dent Res 2011;3:92-94. Linguistic Revision: The English in this manuscript has been checked by at least two professional editors, both native speakers of English.
Distraction Osteogenesis in management of mandibular deformities
Medical Journal Armed Forces India, 2005
Background : The concept of Distraction Osteogenesis is applied in Maxillofacial surgery extensively in the recent past, revolutionizing the concept of management of facial deformities specially the mandible. Methods : This article describes intra oral mandibular distractors in managing mandibular deformities in 9 cases. Conclusion: Surgical intervention is possible in very young patients. Distraction Osteogenosis does not reduce the need for orthodontic intervention. A multifarious approach to the problem, should form the basis of treatment of mandibular deformities.
Distraction osteogenesis in a severe mandibular deficiency
Head & face medicine, 2007
Distraction osteogenesis is an alternative treatment method for the correction of mandibular hypoplasia. In this case report, distraction with a multidirectional extraoral device was performed to gradually lengthen the corpus and ramus of a patient who had a severe hypoplastic mandible. The patient underwent bilateral extraoral ramus and corpus distraction osteogenesis. After seven days of latency period, distraction was performed 0.5 mm twice a day. Subsequent consolidation period was 12 weeks. The patient's mandible was elongated successfully. Cephalometric analysis revealed that ANB angle decreased from 13 degrees to 6 degrees , overjet of 15 mm decreased to 4 mm, corpus length increased from 49 mm to 67 mm, and ramus length increased from 41 mm to 43 mm. Posterior airway space (PAS) also increased due to advancement of the mandible. In stereolithographic model evaluation it was determined that the distances from condylion to gonion and from gonion to pogonion increased. Sati...
The Journal of craniofacial surgery, 2014
This study analyzed the outcomes of nongrowing patients with unilateral mandibular hypoplasia treated according to a specific protocol, which combines distraction osteogenesis, orthodontic treatment, and conventional osteotomies. The patients treated were objectively evaluated. Patient's satisfaction was assessed by questionnaire. Surgical changes were analyzed using cephalometry and three-dimensional facial surface data before surgery (T0) and at long-term (T1) follow-up. Four patients were included in this study. The normalization of facial proportion and a high increase in symmetry were evident. Residual defects were documented in the postoperative symmetry of the chin. In the questionnaire, all patients gave favorable responses to their facial changes; for most of the objective parameters, all patients improved. A multistage treatment protocol for the correction of facial deformities in patients with unilateral mandibular hypoplasia is a valid procedure for skeletal and occl...
Distraction osteogenesis for correcting maxillo-mandibular deformities
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2012
OBJECTIVE To determine the effectiveness of distraction osteogenesis (DO) for correcting maxillofacial deformities. STUDY DESIGN Case series. PLACE AND DURATION OF STUDY Department of Oral and Maxillofacial Surgery, Armed Forces Institute of Dentistry, Rawalpindi, from June 2008 to November 2010. METHODOLOGY Patients with diverse maxillofacial deformities were selected for the study. In all cases, intraoral distractors were used. Mandibular osteotomies were done using submandibular incision and maxillary osteotomy was done using standard vestibular incision. In paediatric patients, DO was started on third postoperative day while in adults, a 7-day latency period was followed. Distraction was carried out at a rate of 0.5 mm twice daily (1 mm/day). Distractors were removed after a consolidation period of 2 months. RESULTS A total 7 cases were operated for DO. Out of these, 3 were males and 4 females. The age ranged from 2-24 years (mean 12.57 + 9.48 years). Five patients had their def...