Distraction osteogenesis: a method to improve facial balance in asymmetric patients

Distraction osteogenesis is a well-established surgical procedure to elongate the maxillofacial skeleton. The authors propose a new method to balance facial asymmetry by means of distraction of the inferior borders of the mandible, without change of the occlusion, using an alveolar device. Nine patients with asymmetry were treated. Records included panoramic radiographs and computed tomographic scans. Preoperatively, stereolithographic models and virtual-reality surgery were performed to have a precise surgical planning. The surgical procedure was based on segmental inferior osteotomy and simultaneous positioning of the alveolar device upside-down. Postoperative clinical evaluation demonstrated that a very impressive elongation of the inferior bony border with simultaneous expansion of the soft tissues had been achieved, resulting in a satisfying facial balance. The postdistraction radiographs showed the ossification of the gap, and the new bone formation was observed and confirmed by biopsy. Distraction osteogenesis of the inferior border of the mandible and the chin represents a new method to correct facial asymmetry and is a valid alternative to the traditional techniques. In addition, surgical virtual reality and stereolithographic models are, without a doubt, an advantage in defining the vector of distraction and in simulating the final result.