Combined maxillary and mandibular distraction osteogenesis in patients with hemifacial microsomia.
BACKGROUND
Hemifacial microsomia is a deformity of variable expressivity with unilateral hypoplasia of the mandible and the ear. In this study, we evaluated skeletal soft tissue changes after bimaxillary unilateral vertical distraction.


METHODS
Eight patients (4 preadolescents 4 adolescents) each with a grade II mandibular deformity underwent a LeFort I osteotomy and an ipsilateral horizontal mandibular ramus osteotomy. A semiburied distraction device was placed over the ramus, and intermaxillary fixation was applied. Anteroposterior cephalometric and frontal photographic analyses were conducted before and after distraction. Statistics were used to analyze the preoperative and postoperative changes.


RESULTS
Cephalometrically, the nasal floor and the occlusal and gonial plane angles decreased. The ratios of affected-unaffected ramus and gonial angle heights improved by 15% and 20%, respectively. The position of menton moved toward the midline. The photographic analysis showed a decrease of the nasal and commissure plane angles, and the chin moved to the unaffected side. The parallelism between the horizontal skeletal and soft tissue planes improved, with an increase in the affected side ramus height and correction of the chin point toward the midline.


CONCLUSIONS
Simultaneous maxillary and mandibular distraction improved facial balance and symmetry. Patients in the permanent dentition with fixed orthodontic appliances and well-aligned dental arches responded well to this intervention.
Associate professor, Department of Pedodontics and Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; formerly, postdoctoral fellow, Department of Anatomy and Rush Craniofacial Center, Rush University Medical Center, Chicago, Ill.
Eduardo Franzotti
EF
Sant'Anna
PhD student, Department of Pedodontics and Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; formerly, postdoctoral fellow, Department of Anatomy and Rush Craniofacial Center, Rush University Medical Center, Chicago, Ill.
Geórgia W T
GW
Lau
Postdoctoral fellow, Department of Pedodontics and Orthodontics, School of Dentistry, Federal University of Rio de Janeiro; Brazilian Army dentist, Santa Maria, Rio de Janeiro, Brazil.
Mariana
M
Marquezan
Associate professor, Department of Pedodontics and Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; formerly, postdoctoral fellow, Department of Anatomy and Rush Craniofacial Center, Rush University Medical Center, Chicago, Ill.
Mônica Tirre
MT
de Souza Araújo
Codirector, Craniofacial Center, Department of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, Ill.
John W
JW
Polley
Codirector, Craniofacial Center, Department of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, Ill. Electronic address: Alvaro_Figueroa@rush.edu.
Alvaro A
AA
Figueroa
D000293:Adolescent; D002508:Cephalometry / Q000379:methods; D002648:Child; D002680:Chin / Q000473:pathology; D005145:Face / Q000473:pathology; D005500:Follow-Up Studies; D006053:Goldenhar Syndrome / Q000601:surgery*; D006801:Humans; D007180:Incisor / Q000473:pathology; D016268:Internal Fixators; D019248:Jaw Fixation Techniques / Q000295:instrumentation; D008334:Mandible / Q000473:pathology / Q000601:surgery*; D008335:Mandibular Condyle / Q000473:pathology; D063168:Mandibular Osteotomy / Q000379:methods; D008437:Maxilla / Q000473:pathology / Q000601:surgery*; D008963:Molar / Q000473:pathology; D009295:Nasal Bone / Q000473:pathology; D009296:Nasal Cavity / Q000473:pathology; D010012:Osteogenesis / Q000502:physiology; D019857:Osteogenesis, Distraction / Q000295:instrumentation / Q000379:methods*; D019340:Osteotomy, Le Fort / Q000379:methods; D010781:Photography / Q000379:methods; D056739:Pterygopalatine Fossa / Q000601:surgery; D015050:Zygoma / Q000473:pathology