Distraction osteogenesis: its application in severe mandibular deformities in hemifacial microsomia

The reconstruction of severe mandibular deformities in patients with hemifacial microsomia (HFM) is difficult. The multiple requirements include temporomandibular joint construction, mandibular ramus and body reconstructions with autogenous bone grafts, and soft tissue facial augmentation. The sequencing of these reconstructions include staged procedures, generally performed at the time of skeletal maturity. Mandibular distraction osteogenesis has gained popularity as a technique for managing patients with mandibular hypoplasia. However, the use of distraction osteogenesis in HFM patients with severe grade III mandibular deformities has not been previously addressed. The purpose of this report is to present our early findings with the clinical application of mandibular distraction osteogenesis in HFM patients with grade III mandibular deformities. In selected patients, mandibular distraction osteogenesis can be beneficial by improving overall facial symmetry and balance. Mandibular distraction osteogenesis has unique advantages for these patients in that it can be performed early in childhood with minimal morbidity. Through the use of clinical examples, the application, patient selection, and advantages and disadvantages of mandibular distraction osteogenesis in HFM patients with grade III mandibular deformities are discussed.