Evaluation of molar teeth and buds in patients submitted to mandible distraction: long-term results.
BACKGROUND
Despite all benefits offered by mandible distraction, complications and long-term consequences need to be evaluated to define its safety and morbidity. Forty mandible distractions were studied. Panoramic mandible radiographs obtained preoperatively, during distraction, and during the postoperative period were reviewed, with the intention of evaluating development and complications of molar buds and teeth in the distraction area.


METHODS
The mean patient age was 8.1 years. Twenty-five patients had craniofacial microsomia (one associated with a no. 10 facial cleft), five had temporomandibular joint ankylosis, two had familiar cases of auriculocondylar syndrome, one had a Tessier no. 30 facial cleft, and one had Treacher Collins syndrome. The severity of mandible hypoplasia was Pruzansky grade I in four cases, grade IIA in eight cases, grade IIB in 16 cases, and grade III in one case. Mean radiographic follow-up was 44.8 months.


RESULTS
Molar buds located in the distraction area erupted without any deformity or displacement in 18 sides (45 percent). Fourteen cases presented distalization of a dental bud to a superior position in the mandibular ramus (four migrated back to the original position). Six molar buds presented perforations, four had shape deformities (two caused by dental fracture), and two had dental root injuries followed by root absorption lately. One case developed a dentigerous cyst.


CONCLUSIONS
Almost half of the patients did not have any molar bud or tooth alterations after mandible distraction, and more than 20 percent presented only bud distalization. Therefore, preventive bud enucleation or tooth extraction should be avoided before mandible distraction.
da Silva Freitas
Renato
R
Curitiba and São Paulo, Brazil From the Assistance Center for Cleft Lip and Palate; Plastic Surgery Unit, Federal University of Parana; and Plastic Surgery Unit, São Paulo University.
Tolazzi
André R D
ARD
Alonso
Nivaldo
N
Cruz
Gilvani A O
GAO
Busato
Luciano
L
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D006801:Humans; D008334:Mandible / Q000601:surgery*; D008963:Molar / Q000254:growth & development*; D019857:Osteogenesis, Distraction / Q000009:adverse effects; D013997:Time Factors