Long-term stability and growth following unilateral mandibular distraction in growing children with craniofacial microsomia.
BACKGROUND
The purpose of this study was to evaluate long-term mandibular skeletal stability and growth following unilateral mandibular distraction in growing children.


METHODS
This retrospective longitudinal study of 12 consecutive patients with unilateral craniofacial microsomia who underwent mandibular distraction had a range of 5 years of postdistraction follow-up; five patients were followed for 10 years. Records included clinical photographs, dental study models, lateral and posteroanterior cephalograms, and panoramic radiographs obtained before distraction, at the time of device removal, and 1, 5, and 10 years after distraction. The mean patient age at the time of distraction was 48 months. The device was activated an average of 21.7 mm at the rate of 1 mm per day. The mean latency period was 6.1 days, and the mean consolidation period was 60.6 days. Fifty-two parameters were examined at each of the five time intervals.


RESULTS
On average, the ramal length (condylion to gonion) increased 13.04 mm in the distracted rami. At 1 year after distraction, this dimension decreased by 3.46 mm. At 5 and 10 years after distraction, the average condylion-gonion dimension increased by 3.83 and 4 mm, respectively, with an average growth rate of 0.87 mm per year; during the same period, the unaffected ramus grew 1.15 mm per year.


CONCLUSIONS
The distraction technique does not eliminate the inherent growth potential of the affected mandibular side. Facial asymmetry is significantly improved after distraction, and despite mild relapse observed during the first year, surgical correction is stable in the later years of follow-up.
Shetye
Pradip R
PR
New York, N.Y. From the Institute of Reconstructive Plastic Surgery, New York University Medical Center.
Grayson
Barry H
BH
Mackool
Richard J
RJ
McCarthy
Joseph G
JG
D002508:Cephalometry; D002648:Child; D002657:Child Development; D002675:Child, Preschool; D019465:Craniofacial Abnormalities / Q000601:surgery*; D005146:Facial Asymmetry / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008334:Mandible / Q000254:growth & development / Q000601:surgery*; D019186:Mandibular Advancement; D019857:Osteogenesis, Distraction; D012189:Retrospective Studies