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Treatment of Facial Asymmetry Using Distraction Osteogenesis in a Mandible First Approach.

Adi Rachmiel1,2, Tal Capucha1, Jiriys George Ginini1

  • 1From the Department of Oral and Maxillofacial Surgery, Rambam Medical Center, Haifa, Israel.

Plastic and Reconstructive Surgery. Global Open
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Summary

This study shows a two-stage surgical approach effectively corrects facial asymmetry in young adults. Mandible distraction osteogenesis followed by maxillary Le-Fort I surgery significantly improves symmetry and occlusion with minimal relapse.

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Area of Science:

  • Craniofacial surgery
  • Orthognathic surgery
  • Pediatric plastic surgery

Background:

  • Facial asymmetry stems from childhood trauma or congenital conditions like hemifacial microsomia.
  • Management in adolescents and young adults often requires complex surgical intervention.
  • A staged approach addressing the mandible first is explored.

Purpose of the Study:

  • To describe a two-stage surgical protocol for managing facial asymmetry.
  • To evaluate the efficacy of a mandible-first distraction osteogenesis followed by maxillary Le-Fort I osteotomy.
  • To assess outcomes in adolescent and young adult patients.

Main Methods:

  • Eighteen patients (14-25 years) with unilateral hypoplasia underwent treatment.
  • Surgical protocol involved unilateral mandibular distraction osteogenesis, then Le-Fort I osteotomy.
  • Additional procedures like bone grafting and genioplasty were performed as needed.

Main Results:

  • Significant mandibular elongation (18.94 mm) and forward traction (12.5 mm) achieved symmetry.
  • Maxillary repositioning ensured proper midline alignment and occlusion.
  • Cephalometric analysis confirmed ramus elongation, improved symmetry, and corrected occlusal canting with minimal relapse (47.4-month follow-up).

Conclusions:

  • A two-stage surgical approach (mandible distraction then maxillary repositioning) effectively corrects facial asymmetry.
  • Optimal timing (ages 14-18) and this protocol yield stable, long-term results.
  • Transverse deficiency at the gonial angle may necessitate bone grafting or patient-specific implants.