Intraoral Premaxillary Distraction in a Patient With Maxillary Retrognathic Cleft Lip and Palate: A Case Report.

Patients with cleft lip and palate sometimes have a retruded maxilla. Here, we describe the case of a young man in whom crowding of the maxillary teeth and an anteroposterior discrepancy of the maxilla were resolved by premaxillary distraction osteogenesis (DO) using 3 individual intraoral distractors. Our experience in this patient confirms that premaxillary DO with 3 intraoral distractors and preoperative simulation can achieve stable maxillary advancement and arch expansion without impairing velopharyngeal incompetence.

Treatment of Micrognathia by Intraoral Distraction Osteogenesis: A Prospective Study.

PURPOSE: Maxillofacial deformities are always psychologically and physically distressing to the patients and is also challenging to the treating surgeons. The term Micrognathia means a "small jaw". True micrognathia, where the maxilla or the mandibular skeleton does not grow to the full size can be congenital or acquired. Distraction osteogenesis also called as callus distraction or callostasis or osteodistraction or distraction histogenesis is a biological process of regenerating newly formed bone and adjacent soft tissue by a gradual and controlled traction of surgically separated bone segments. The purpose of this prospective study was to assess the versatility of distraction osteogenesis in the treatment of micrognathia. MATERIALS AND METHODS: Four patients (three males and one female) with micrognathia of mandible were included in this prospective study. The patients were between the age group of 10-20 years. Facial asymmetry was the chief complaint of all the patients. In all the patients following treatment protocol was carried out, Osteotomy and placement of intraoral distraction device under general anaesthesia, latency phase (5-7 days), activation period-rate 1.5 mm per day, consolidation period of 8 weeks, removal of distraction device under local anaesthesia. The parameters assessed were ramus height, body length, hyo mental distance, posterior pharyngeal airway space, chin projection, facial symmetry occlusion, mid line shift pre and post operatively. RESULTS: The mean increase in ramus height achieved was 9.2 + 2.17 mm and the mandibular body length achieved was 10.4+1.67 mm. There was an average increase in hyo-mental distance of 2.75 cm +0.9 cm postoperatively showing a definitive improvement in the airway. The posterior pharyngeal space measured from the lateral cephalogram preoperatively ranged from 3-6 mm and post operatively from 6-9 mm.Intraorally there was a shift in occlusion to class I molar relation in three patients and there was posterior open bite in one patient. Marked correction of facial asymmetry was noticed in all cases both clinically and in PA cephalogram. There was a restoration of dental as well as lip midline and improved lip competence. There was a significant improvement in chin projection and occlusal cant however further chin correction was needed in one case by means of advancement genioplasty. CONCLUSION: A definite improvement in all parameters such as body length,ramus height,chin projection,occlusal cant was observed in all patients. Moreover the patients were subjectively satisfied with the outcome of the results. Distraction Osteogenesis is definitely a boon to the oral and maxillofacial surgeons in treating large deficiencies of mandible in terms of stability.

Simultaneous gap arthroplasty and intraoral distraction and secondary contouring surgery for unilateral temporomandibular joint ankylosis.

BACKGROUND: Temporomandibular joint (TMJ) ankylosis can be accompanied by various degrees of functional and esthetic problems. Adequate mouth opening, occlusal stability, and harmonious facial form are the main goals of treatment for ankylosis. Distraction osteogenesis has proven to be an excellent treatment for lengthening the ramus-condyle unit. However, various timings for distraction have been suggested, and there is no consensus on selection criteria for performing the procedure in stages or simultaneously with other treatments. CASE PRESENTATION: In this case report, concomitant intraoral distraction and gap arthroplasty was planned to treat TMJ ankylosis and associated facial asymmetry. After gap arthroplasty and 23 mm of distraction, the ramus-condyle segment was successfully lengthened and mouth opening range was significantly increased. The resultant interocclusal space was stably maintained with an occlusal splint for 4 months after distraction. Finally, good occlusion was achieved after prosthetic treatment. The remaining mandibular asymmetry was corrected with osseous contouring and augmentation surgery. The mouth-opening range was maintained at 35 mm 24 months after treatment. CONCLUSION: Gap arthroplasty with intraoral distraction as a one-stage treatment and subsequent contouring surgery can be applied to correct ankylosis with moderate malocclusion and facial asymmetry.

Simultaneous gap arthroplasty and intraoral distraction and secondary contouring surgery for unilateral temporomandibular joint ankylosis / 대한악안면성형재건외과학회지

BACKGROUND: Temporomandibular joint (TMJ) ankylosis can be accompanied by various degrees of functional and esthetic problems. Adequate mouth opening, occlusal stability, and harmonious facial form are the main goals of treatment for ankylosis. Distraction osteogenesis has proven to be an excellent treatment for lengthening the ramus-condyle unit. However, various timings for distraction have been suggested, and there is no consensus on selection criteria for performing the procedure in stages or simultaneously with other treatments. CASE PRESENTATION: In this case report, concomitant intraoral distraction and gap arthroplasty was planned to treat TMJ ankylosis and associated facial asymmetry. After gap arthroplasty and 23 mm of distraction, the ramus-condyle segment was successfully lengthened and mouth opening range was significantly increased. The resultant interocclusal space was stably maintained with an occlusal splint for 4 months after distraction. Finally, good occlusion was achieved after prosthetic treatment. The remaining mandibular asymmetry was corrected with osseous contouring and augmentation surgery. The mouth-opening range was maintained at 35 mm 24 months after treatment. CONCLUSION: Gap arthroplasty with intraoral distraction as a one-stage treatment and subsequent contouring surgery can be applied to correct ankylosis with moderate malocclusion and facial asymmetry.

Implant Installation After Mandibular Alveolar Ridge Augmentation Using Intraoral Distraction Device: Report Of 5 Cases

EFFECT OF THE LATENCY PERIOD ON ALVEOLAR RIDGE DISTRACTION USING THE INTRAORAL DISTRACTION DEVICE IN DOGS

ALVEOLAR RIDGE AUGMENTATION USING INTRAORAL DISTRACTION DEVICE IN DOGS

The aim of this study was to show the feasibility and potential advantages of using the new intraoral distraction device for alveolar ridge augmentation. Four adult mongrel dogs were used. We designed intraoral distraction device for augmentation of vertical height of the edentulous ridge. The left upper and lower premolars and first molars were extracted and an alveoloplasty was performed to simulate an atrophic ridge. After 12 weeks of healing, an osteotomy was made and the intraoral distraction device was applied in order to distract alveolar segment upward. A permucosal pin was exposed intraorally. Latency period was allowed for 7 days before distraction began. The distraction device was activated with a rate of 1.0 mm/day for 9 days. At 2 weeks after completion of the distraction, the device was removed. At 8 weeks after distraction, the animals were sacrificed. Clinical, radiographic, and histologic examinations were performed. Macroscopically, no significant abnormalities such as infection were occurred in the distracted area. The average distracted distance was 7.6+/-1.4 mm and new bone was formed in the distracted gap in all animals. Bone remodeling without crestal bone resorption was observed in the distracted area. In several animals, fibrous tissue was present in the buccal cortical bone area. These results suggest that the intraoral diatraction device may have the potential for use in augmentation of the atrophic edentulous ridge.