Transverse Mandibular Distraction Technique for Complex Craniofacial Reconstruction

A very important method in the management of maxillomandibular discrepancies with pronounced hypoplasia of the upper or lower jaw is distraction osteogenesis. With distraction osteogenesis, it is possible to correct functional abnormalities, improve problems related to airway obstruction, and enhance overall soft tissue harmony in ways that would otherwise not be possible with traditional osteotomy and fixation techniques, particularly in the growing skeleton. For patients with severe transverse mandibular discrepancies, distraction osteogenesis is a viable option for correcting the mandibular width. Here, we present a case of successful transverse mandibular expansion using a novel tooth-borne transverse distraction appliance. This patient with congenital anomalies leading to severe class II malocclusion, bilateral posterior crossbite, and challenges in chewing underwent treatment for transverse mandibular correction. A custom-designed tooth-borne mandibular distractor was fabricated by the orthodontic team and placed on the lower dental arch following a midline mandibular osteotomy. At-home expansion began on postoperative day 3 and continued until imaging and clinical examination findings demonstrated acceptable mandibular width. Additional mandibular ramus lengthening was performed several months later in a typical manner. Follow-up demonstrated acceptable posterior overjet, mandibular form, and mandibular width with correction of the transverse mandibular deficiency. This case represented a novel technique for successful treatment of mandibular micrognathia in the transverse dimension. The device presented here should be found useful in the management of patients with complex mandibular dysmorphology associated with transverse deficiency, thanks to its versatility and minimal complication profile.