[Multidimensional distraction osteogenesis for profile correction in severe facial asymmetries]

If treatment fails, mandibular hypoplasia, especially in unilateral cases, can cause severe facial asymmetries that worsen as the patient ages. Even distraction osteogenesis becomes more important as an early treatment concept, with regard to traditional therapies in a unidirectional application, if skeletal malformations are treated incompletely. In most cases of mandibular hypoplasia there are bone deficits in the vertical, horizontal and transverse direction, which lead to various problems in the skeletal profile. Therefore, we developed a multidirectional distractor to normalize a hypoplastic mandibular area in an almost anatomical manner. This device consists of two geared rods with a infinitely variable ball joint. It enables us to create one or two callus fields on each side and correct the profile on several levels. This is the decisive advantage in comparison with the intraoral devices that work only in one plane. Using a clinical example, the indication, technique and possibilities of multidirectional callus distraction are illustrated and discussed.