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Treatment of Facial Asymmetry Using Distraction Osteogenesis in a Mandible First Approach
BACKGROUND: Facial asymmetry includes several etiologies, among them trauma to the condylar area during early childhood and congenital malformations such as hemifacial microsomia. This article describes the management of facial asymmetry in adolescents and young adults using a mandible first approac...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott Williams & Wilkins
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10511035/ https://www.ncbi.nlm.nih.gov/pubmed/37736071 http://dx.doi.org/10.1097/GOX.0000000000005255 |
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author | Rachmiel, Adi Capucha, Tal Ginini, Jiriys George Emodi, Omri Aizenbud, Dror Shilo, Dekel |
author_facet | Rachmiel, Adi Capucha, Tal Ginini, Jiriys George Emodi, Omri Aizenbud, Dror Shilo, Dekel |
author_sort | Rachmiel, Adi |
collection | PubMed |
description | BACKGROUND: Facial asymmetry includes several etiologies, among them trauma to the condylar area during early childhood and congenital malformations such as hemifacial microsomia. This article describes the management of facial asymmetry in adolescents and young adults using a mandible first approach by distraction osteogenesis, followed by maxillary Le-Fort I as a second stage. METHODS: Eighteen patients 14–25 years of age presented with unilateral hypoplasia of the jaws which manifested clinically by deviation of the chin and canting of the occlusal plane. Etiology included hemifacial microsomia and trauma injuries at early childhood. All patients underwent orthodontic treatment and two phases of surgical treatment. Surgical treatment included unilateral mandibular distraction followed by Le-Fort I osteotomy for alignment of the maxilla. Additional bone graft in the affected side and sliding genioplasty were done as required. RESULTS: Marked ramal elongation of 18.94 mm concomitant with mandibular forward traction of 12.5 mm was noted while achieving symmetry. In all cases, the maxilla was centered to the midline in proper occlusion. Post distraction, posteroanterior cephalometric radiographs demonstrated elongation of the affected ramus, improvement in facial symmetry, and correction of the occlusal canting. Relapse was minimal based on long-term follow-ups of 47.4 months. CONCLUSIONS: The two-stage surgical approach that includes elongation of the mandible as a first stage followed by adaptation of the maxilla is useful in correcting facial asymmetry. Using this protocol at the correct age (14–18) is very stable, as demonstrated by our results, yet one should always remember the transverse deficiency in the gonial angle requires additional bone grafting or patient specific implants. |
format | Online Article Text |
id | pubmed-10511035 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-105110352023-09-21 Treatment of Facial Asymmetry Using Distraction Osteogenesis in a Mandible First Approach Rachmiel, Adi Capucha, Tal Ginini, Jiriys George Emodi, Omri Aizenbud, Dror Shilo, Dekel Plast Reconstr Surg Glob Open Craniofacial/Pediatric BACKGROUND: Facial asymmetry includes several etiologies, among them trauma to the condylar area during early childhood and congenital malformations such as hemifacial microsomia. This article describes the management of facial asymmetry in adolescents and young adults using a mandible first approach by distraction osteogenesis, followed by maxillary Le-Fort I as a second stage. METHODS: Eighteen patients 14–25 years of age presented with unilateral hypoplasia of the jaws which manifested clinically by deviation of the chin and canting of the occlusal plane. Etiology included hemifacial microsomia and trauma injuries at early childhood. All patients underwent orthodontic treatment and two phases of surgical treatment. Surgical treatment included unilateral mandibular distraction followed by Le-Fort I osteotomy for alignment of the maxilla. Additional bone graft in the affected side and sliding genioplasty were done as required. RESULTS: Marked ramal elongation of 18.94 mm concomitant with mandibular forward traction of 12.5 mm was noted while achieving symmetry. In all cases, the maxilla was centered to the midline in proper occlusion. Post distraction, posteroanterior cephalometric radiographs demonstrated elongation of the affected ramus, improvement in facial symmetry, and correction of the occlusal canting. Relapse was minimal based on long-term follow-ups of 47.4 months. CONCLUSIONS: The two-stage surgical approach that includes elongation of the mandible as a first stage followed by adaptation of the maxilla is useful in correcting facial asymmetry. Using this protocol at the correct age (14–18) is very stable, as demonstrated by our results, yet one should always remember the transverse deficiency in the gonial angle requires additional bone grafting or patient specific implants. Lippincott Williams & Wilkins 2023-09-11 /pmc/articles/PMC10511035/ /pubmed/37736071 http://dx.doi.org/10.1097/GOX.0000000000005255 Text en Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. |
spellingShingle | Craniofacial/Pediatric Rachmiel, Adi Capucha, Tal Ginini, Jiriys George Emodi, Omri Aizenbud, Dror Shilo, Dekel Treatment of Facial Asymmetry Using Distraction Osteogenesis in a Mandible First Approach |
title | Treatment of Facial Asymmetry Using Distraction Osteogenesis in a Mandible First Approach |
title_full | Treatment of Facial Asymmetry Using Distraction Osteogenesis in a Mandible First Approach |
title_fullStr | Treatment of Facial Asymmetry Using Distraction Osteogenesis in a Mandible First Approach |
title_full_unstemmed | Treatment of Facial Asymmetry Using Distraction Osteogenesis in a Mandible First Approach |
title_short | Treatment of Facial Asymmetry Using Distraction Osteogenesis in a Mandible First Approach |
title_sort | treatment of facial asymmetry using distraction osteogenesis in a mandible first approach |
topic | Craniofacial/Pediatric |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10511035/ https://www.ncbi.nlm.nih.gov/pubmed/37736071 http://dx.doi.org/10.1097/GOX.0000000000005255 |
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