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Surgery-First Orthognathic Surgery Combined with Mandibular Distraction Osteogenesis using Double Distractor Technique for Severe Facial Asymmetry: Case Report

Yorikatsu Watanabe¹ , Ryo Sasaki², Tanetaka Akizuki¹

  1. Plastic, Reconstructive & Aesthetic Surgery, Tokyo Metropolitan Police Hospital, Tokyo, Japan
  2. Oral & Maxillofacial Surgery, Tokyo Women’s Medical University
Background:

Severe facial asymmetry in adults with hemifacial microsomia (HFM) or temporomandibular joint ankyloses (TMJA) has been challenged to treat using simultaneous maxillomandibular distraction using external distractor placed on the mandible with intermaxillary fixation (IMF).

However external distractor also produces significant distress for patients during at least 8 weeks. Furthermore mandibular-driven distraction tends to elongate the mid face with difficulty of positioning not only the center of the maxilla in the center of the face but also horizontalization of the occlusal plane. To overcome these disadvantages and obtain a better aesthetic result, we performed intraoperative Le Fort I procedure to restore maxillary roll levering and mandibular distraction using two types of mandibular distractors for better controlled and tolerable postoperative distraction osteogenesis.

Methods:

After Le Fort I osteotomy, the Le Fort I segment was intraoperatively restored and fixed to centralize the center of the maxilla in the center of the face and horizontalize the occlusal plane according to the preoperative simulation plan and intraoperative adjustments of facial soft tissues. Before osteotomy of the mandible, two types of mandibular distractor, external and internal device, were placed to the affected side of mandibular rams. Finally the vertically osteotomy of the unaffected side of mandible was performed. After the completion of distraction with IMF using soft fires or elastic bands, the external distractor was removed. The external distractor was used to control the direction of distraction three dimensionally. The internal distractor was used to follow the direction controlled by the external distractor during the distraction period and keep the distracted zone stable during the consolidation period.

Results:

Representative case: A 25-year-old female with severe facial asymmetry had satisfactory correction without complication.

Conclusions:

Simultaneous maxillary repositioning and mandibular distraction using double distractor technique based on Surgery-First concept successfully restored severe facial asymmetry and occlusal plane in adults with severe facial asymmetry such as HFM or TMJA.