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Micrognathic mandible correction using simultaneous internal maxillomandibular distraction osteogenesis

17/2/2016

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22 year old female, a known case of bilateral TMJ ankylosis reported to our hospital for the surgical correction of lower half of the face. Micrognathic mandible present due to retarded development. She gave the history of TMJ ankylosis release surgery done elsewhere during childhood.
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. Bilaterally Paragingival incision was placed over the 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. Thus maxillomandibular distraction technique helped dramatically to enhance the facial appearance without any visible scars and taking autobone graft anywhere from the body. Patient feels very happy to have enhanced facial appearance without any scar on the face.
Retruded mandible due to bilateral temporomandibular joint ankylosis
Retruded mandible with illdefined chin prominence
Intraoperative view showing intraoral fixation of maxillomandibular distractors
Postoperative view after distraction shows forwardly moved mandible without any visible scars on the face
Postoperative profile view showing advanced lower jaw with enhanced chin prominence
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