title: Installing an original sleeve for rod unaccessible pain from a distraction device in a hemifacial microsomia patient.
abstract: BACKGROUND
  Lengthening of the mandible by distraction osteogenesis using an internal device is the preferred method for the treatment of hemifacial microsomia. Despite its advantages, this technique can lead to various complications after the surgery.
  
  
  METHODS
  We report the case of an 8-yr-old Japanese girl whose case presented practical difficulties in device activation because of rod unaccessible pain after the initial mandibular distraction with an internal device, and this complication was addressed with the installation of an original sleeve.
  
  
  CONCLUSIONS
  In the present patient, the region of the bend rod was located at the inferior border of the right mandible, causing rod unaccessible pain by contacting the surrounding tissue including a sensory nerve. Careful vertical ramus distractor position planning and tools to resolve complications are the key factors for accomplishing the scheduled elongation.
  
  
  CONCLUSIONS
  Alternative techniques using a sleeve for safer and gentle distraction for rod unaccessible pain on activation should be considered.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8525, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Shimo
authors.affiliation: Department of Oral and Maxillofacial Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8525, Japan. Electronic address: anishi@md.okayama-u.ac.jp.
authors.forename: Akiyoshi
authors.initials: A
authors.lastname: Nishiyama
authors.affiliation: Department of Oral and Maxillofacial Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8525, Japan.
authors.forename: Norie
authors.initials: N
authors.lastname: Yoshioka
authors.affiliation: Department of Oral and Maxillofacial Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8525, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Sasaki
keywords: Distraction osteogenesis; Hemifacial microsomia; Original sleeve