RESUMO
Distraction osteogenesis has been used to lengthen the mandible in patients with hemifacial microsomia. Questions regarding soft tissue and skeletal growth after distraction osteogenesis have not been clearly elucidated in the literature. In this case report, a 2-year follow-up of distraction osteogenesis in a 7 year old boy is documented with lateral and posterior/anterior cephalometric analysis. The analysis was performed preoperatively and at specific postsurgical periods to evaluate the facial soft tissue and skeletal growth patterns. Objective analysis of this growing patient after distraction osteogenesis clearly demonstrates that the anteroposterior elongation of the mandible is relatively stable, whereas the vertical lengthening and soft tissue effects are minimal. Critical evaluation of other patients who have undergone distraction osteogenesis is needed to determine if this was an isolated incident or the expected result in similar patients.
Assuntos
Assimetria Facial/cirurgia , Mandíbula/cirurgia , Osteogênese por Distração , Anormalidades Múltiplas , Cefalometria/estatística & dados numéricos , Criança , Assimetria Facial/diagnóstico por imagem , Seguimentos , Humanos , Masculino , Mandíbula/diagnóstico por imagem , Osteogênese por Distração/instrumentação , Osteogênese por Distração/métodos , Osteotomia , Radiografia , Fatores de TempoRESUMO
The dental literature recognizes that performing sagittal ramus osteotomy when impacted third molars are present significantly increases the risk of unfavorable fractures of both the proximal and distal segments. Many articles have described how to repair unfavorable fractures of sagittal split segments, but few to date specifically address how to modify the osteotomy design to reduce the potential for unfavorable fractures. Moreover, techniques for removal of impacted third molars after the completion of a sagittal split ramus osteotomy have received little attention in the literature, yet it is obviously a common occurrence. This paper describes a modification of the sagittal split ramus osteotomy when a fully formed impacted third molar is present at the time of the sagittal ramus osteotomy. A technique is also described for removing the impacted third molar after the sagittal split is completed. Clinical experience has demonstrated these techniques to have several advantages.
