A 22 year old girl reported to our hospital for the surgical correction of asymmetry over the left side of the face. Facial asymmetry may be present in cases of hemifacial microsomia, TMJ ankylosis or may have resulted following condylar fractures. This patient had a mandibular deficiency at the ramus level and deficiency measured almost 14 mm with a resultant occlusal cant.
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After thorough clinical and radiological examination Maxillofacial Surgeon Dr. S. M. Balaji planned to correct the facial asymmetry using internal distraction osteogenesis with maxillomandibular distractor. Paragingival incision was placed over the left angle region along the anterior border of ramus. Full thickness mucoperiostal flap was reflected buccally and bone exposed. The direction of the osteotomy cut and positioning of the distractor is the most important as it determines the vector of distraction and this determines the direction of the bone growth. The distractor device was positioned and fixed using screws. Osteotomy is then completed along the medial cortex. Distractor device was checked and wound closure done. Le Fort I osteotomy was completed in maxilla. After a latency period of 5 days, distraction at the rate of 1 mm per day was accomplished and facial asymmetry was successfully corrected. Patient feels very happy to have the facial asymmetry correction without any scars on the face.

An 18-year-old boy afflicted with Parry-Romberg syndrome reported to our hospital seeking to correct his facial asymmetry. His left side face was defective leading to slanting bite and an obvious asymmetry of the face. The radiographic examination showed a grossly under-developed upper and lower jaw on the left side. 

Eminent Craniofacial Surgeon Dr. S. M. Balaji adopted a stage-by-stage rehabilitation. To correct the jaw deformity, he applied the innovative simultaneous maxillary and mandibular distraction procedure. Le Fort I osteotomy was done for the upper jaw. The lower jaw bone was cut and the distractor device has been placed. A screw attached to the distractor is turned gradually at a rate of 1 mm per day. The bone segments move apart and new bone is formed in the gap to lengthen the jaw.  After the required length is achieved and new bone is stabilized, subsequently correcting the asymmetry of the face, the distractor device will be removed. 

This will be followed by correction of soft tissue defect by fat grafting as the second stage. We will be updating this case with more details as the treatment proceeds.