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[Selection of compression-distraction device type for mandibular hypoplasia based on mandible morphometric
F F Losev1, P I Shapovalov1, A A Kulakov1
1Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia.
Objective:
To determine the optimal type of compression distraction device (CDA) for the treatment of mandibular underdevelopment in children.
Materials And Methods:
The archival data of 50 pediatric patients with underdevelopment of the mandible of various etiologies were analyzed. The patients were divided into two groups: group 1 with congenital pathology (syndrome I-II of the branchial arch, unilateral lesion) Group 2 with acquired pathology (consequences of TMJ ankylosis or injury of the condylar process without ankylosis). According to CT data, the length of the body and the height of the mandibular branch on the affected and intact sides were determined, and the degree of asymmetry was calculated. Depending on the nature of the deformation, either a rectilinear intraosseous distractor or a curved one (with a radius of curvature R40-R100) was used. The distribution of types of devices into groups and the correspondence of the choice of KDA to morphometric indicators were evaluated.
Results:
In both groups, the majority of cases (≈90%) required the use of curved distractors, while direct devices were used in only 5 patients (10%). Rectilinear distractors were installed mainly with an isolated horizontal shortening of the mandible body, or with an isolated decrease in the height of the branch. The curved devices made it possible to simultaneously lengthen the body and the mandible branch in one step, eliminating the combination of horizontal and vertical deficits. The radius of curvature was selected individually: for severe vertical underdevelopment of the branch (hemifacial microsomy), a smaller radius (R40) was used, whereas for post-traumatic underdevelopment without a significant decrease in height, a larger radius (R70-R100) was used. In both groups, a significant elongation of the mandible was achieved: an increase in body length averaged 12-14 mm, and the height of the branch was 15-17 mm, which practically eliminated the initial asymmetry.
Conclusion:
In children with combined mandibular underdevelopment, the use of intraoral curved distractors is optimal, which simultaneously compensate for horizontal and vertical deficits. Rectilinear QDs can only be used for isolated shortening in one direction (only the length of the body or only the height of the branch).
