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Simultaneous maxillomandibular distraction in unilateral mandibular hypoplasia
A Martínez Plaza1, M Pérez de Perceval Tara1, E Bullejos Martínez2
1Hospital Universitario Virgen de las Nieves, Oral & Maxillofacial Surgery, Av. de las Fuerzas Armadas, 2 18014 Granada, Spain.
The British Journal of Oral & Maxillofacial Surgery
|March 8, 2020
Summary
Craniomaxillofacial surgery addresses hypoplastic mandibles and asymmetries using simultaneous maxillomandibular distraction. This technique, supported by virtual surgical planning, significantly improves facial aesthetics and skeletal structure.
Area of Science:
- Craniomaxillofacial surgery
- Orthognathic surgery
- Skeletal reconstruction
Background:
- Hypoplastic mandibles and mandibular asymmetries present common skeletal challenges post-growth, including occlusal plane inclination and facial asymmetry.
- Stable dental occlusion often coexists with these skeletal discrepancies, complicating aesthetic and functional correction.
- Effective correction is crucial for achieving acceptable aesthetic outcomes in craniomaxillofacial surgery.
Purpose of the Study:
- To evaluate the efficacy of simultaneous maxillomandibular distraction in correcting hypoplastic mandibles and asymmetries.
- To assess the role of virtual surgical planning, stereolithographic models, and surgical guides in optimizing surgical outcomes.
- To report on the clinical experience with this technique in a cohort of patients with diverse etiologies.
Main Methods:
- Simultaneous maxillomandibular distraction involving Le Fort I osteotomy and mandibular osteotomy with intermaxillary fixation during active distraction.
- Utilization of virtual surgical planning for pre-operative assessment and treatment simulation.
- Application of stereolithographic models and custom surgical guides to aid intraoperative execution.
- Analysis of pre- and post-operative outcomes focusing on facial aesthetics and skeletal parameters.
Main Results:
- Significant improvements were observed in the distance between the lateral canthus and oral commissure, indicating enhanced facial balance.
- Increased mandibular ramus height and correction of the occlusal plane inclination were achieved.
- Improved medial positioning of the chin and overall facial symmetry were noted.
- Virtual surgical planning facilitated the selection of optimal distraction vectors and magnitudes, contributing to excellent outcomes.
Conclusions:
- Simultaneous maxillomandibular distraction is an effective technique for correcting hypoplastic mandibles and asymmetries, yielding substantial aesthetic improvements.
- Virtual surgical planning is a valuable technological tool that enhances treatment precision and optimizes outcomes in complex craniomaxillofacial reconstructions.
- The combined approach offers a promising solution for patients with challenging skeletal discrepancies, leading to improved physical appearance and function.
