title: Simultaneous maxillo-mandibular distraction in early adolescence as a single treatment modality for durable correction of type II unilateral hemifacial microsomia: Follow-up till completion of growth.
abstract: BACKGROUND
  Timing of surgical intervention in hemifacial microsomia (HFM) is controversial. Although mandibular osteodistraction in childhood for HFM is popular, recent data for single-stage distraction in growing HFM patients demonstrated long-term relapse. Literature suggests that adolescents in the late mixed dentition age or permanent dentition age (11-16-year-old) had more stable outcomes post-distraction than younger children. We present favorable experience using single-treatment simultaneous maxillo-mandibular distraction in early adolescent Pruzansky-Kaban type II HFM patients.
  
  
  METHODS
  This was a retrospective longitudinal study of seven consecutive type IIa/b HFM growing patients (12-16-year-old) treated with simultaneous maxillo-mandibular distraction. Oral commissure cant was photographically measured preoperatively and at 6 months and annually ranging 3-7 years post-distraction. Ramus height and chin deviation were measured from radiographs done preoperatively and at distractor-removal, 1 year, 2 years, and 4 years post-distraction.
  
  
  RESULTS
  Average age at osteodistraction and at latest follow-up was 13.7 and 18.6 years, respectively. Improvement was significant (p < 0.05) and sustained for mean oral commissure cant (5.1°-0.41°), mean ramus height ratio (0.59-0.86), and average chin deviation (15.9 mm-1.2 mm). Two subjects had mandibular branch palsy and one had mild pin-tract infection - all resolved. All were satisfied with their facial appearance.
  
  
  CONCLUSIONS
  We have demonstrated good lasting outcomes at completion of growth with single-stage simultaneous maxillo-mandibular distraction for type II HFM adolescents in the late mixed-dentition or older age, and advocate this as an alternative to osteodistraction or orthognathic surgery upon skeletal maturity.
authors: Department of Plastic and Reconstructive Surgery (Head: Prof. Philip Kuo-Ting Chen), Chang Gung Memorial Hospital, Taoyuan, Taiwan; The College of Medicine, Chang Gung University, Taiwan.
authors: Ting-Chen
authors: TC
authors: Lu
authors: Department of Plastic and Reconstructive Surgery (Head: Prof. Philip Kuo-Ting Chen), Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Plastic, Reconstructive and Aesthetic Surgery, KK Women's and Children's Hospital, Singapore.
authors: Gavin Chun-Wui
authors: GC
authors: Kang
authors: Department of Plastic and Reconstructive Surgery (Head: Prof. Philip Kuo-Ting Chen), Chang Gung Memorial Hospital, Taoyuan, Taiwan; The College of Medicine, Chang Gung University, Taiwan.
authors: Chuan-Fong
authors: CF
authors: Yao
authors: Department of Craniofacial Dentistry and Orthodontics, Chang Gung Memorial Hospital, Taipei, Taiwan.
authors: Eric Jein-Wein
authors: EJ
authors: Liou
authors: Department of Craniofacial Dentistry and Orthodontics, Chang Gung Memorial Hospital, Taipei, Taiwan.
authors: Ellen Wen-Ching
authors: EW
authors: Ko
authors: Department of Plastic and Reconstructive Surgery (Head: Prof. Philip Kuo-Ting Chen), Chang Gung Memorial Hospital, Taoyuan, Taiwan; The College of Medicine, Chang Gung University, Taiwan.
authors: Zung-Chung
authors: ZC
authors: Chen
authors: Department of Plastic and Reconstructive Surgery (Head: Prof. Philip Kuo-Ting Chen), Chang Gung Memorial Hospital, Taoyuan, Taiwan. Electronic address: philip@cgmh.org.tw.
authors: Philip Kuo-Ting
authors: PK
authors: Chen
mesh_terms: D000293:Adolescent; D005260:Female; D006053:Goldenhar Syndrome / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008445:Maxillofacial Development; D019857:Osteogenesis, Distraction / Q000379:methods*; D010027:Osteotomy / Q000379:methods; D010781:Photography; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Craniofacial microsomia; Distraction osteogenesis; Early distraction; Long-term results; Separate mandibular and maxillary distractors