The role of distraction osteogenesis in the reconstruction of the mandible in unilateral craniofacial microsomia.
Laboratory and clinical studies have shown that mandibular distraction is an effective and powerful reconstructive surgical technique. It is safely performed without the need for blood transfusion or bone graft. Because of concomitant expansion of the functional matrix (the associated skin, subcutaneous fat, and muscles of mastication), there is a multidimensional expansion of the lower jaw with minimal, if any, evidence of relapse. Moreover, the surgical reconstruction can be commenced by 2 years of age, and the vector of distraction can be controlled by preoperative design. Finally, the increase in resulting mandibular bone stock will provide more reconstructive options in the future for traditional orthognathic surgical techniques. The technique has been criticized, either for the cutaneous incision for the approach to the mandible or for the scar resulting from the path of the distracting screws. However, with careful placement of the device, the resulting scar can be placed in the lines of minimal tension with a resulting satisfactory scar. It has been assumed that the osteotomy results in interruption of the inferior alveolar nerve. However, questioning of the older patients has failed to detect any change in sensation of the lower lip. The status of the inferior alveolar nerve in the hypoplastic mandible has also never been studied. Insertion of the screws required an area of bone stock that is edentulous, and this finding can make application of the device difficult in some patients. The length of treatment has been criticized--approximately 3 months. However, this is offset by the ease of treatment, the degree of safety, and the reduction in hospital time without the need for blood transfusion or bone graft. The results to date indicate that the technique can be applied to the correction of the milder mandibular deficiencies.(ABSTRACT TRUNCATED AT 250 WORDS)
McCarthy
J G
JG
Institute of Reconstructive Plastic Surgery, New York University Medical Center, New York.
D001852:Bone Lengthening / Q000295:instrumentation / Q000379:methods*; D001863:Bone Screws; D002675:Child, Preschool; D002921:Cicatrix / Q000517:prevention & control; D016267:External Fixators; D005146:Facial Asymmetry / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D008334:Mandible / Q000002:abnormalities* / Q000601:surgery*; D010012:Osteogenesis; D010027:Osteotomy / Q000295:instrumentation / Q000379:methods