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Facial asymmetry correction using Distraction osteogenesis

13/5/2016

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Hemifacial microsomia is a condition in which there is an under-development of one side of the face resulting in facial asymmetry. The affected side of the face appears disproportionately smaller than the other. Characteristically, the lower jaw (mandible), facial soft tissues & musculature, cheek and ear on one side of the face is poorly developed. Sometimes, structural defects in the eye may also be seen. A 28-year-old boy afflicted with Hemifacial Microsomia reported to our Hospital. His lower jaw and ear was under-developed on the right side. He had a slanting bite and an obvious asymmetry of the face. A radiographic examination showed a grossly under-developed lower jaw (mandible) on the right side. There was found to be a bone deformity of about 20 mm.
The goal of the treatment is to elongate the deficient jaw bone to restore facial symmetry and correct the slanting bite (occlusion). To achieve this, an advanced and effective treatment technique is distraction osteogenesis. This is a new technique for regenerating new bone by slow, progressive stretching of the bone, without requiring a bone graft.
Eminent Craniofacial Surgeon Dr. S.M. Balaji is a pioneer in introducing this revolutionary technique and has successfully rehabilitated the maximum number of patients afflicted with facial disfigurements in the country.
In distraction osteogenesis, the jaw bone on the deficient side is cut. A sophisticated device called distractor is placed such that the two arms of the device are fixed to the two segments of jaw bone. After a few days, a screw attached to the distractor is turned gradually, ideally at a rate of 1 mm per day. When this is done, the two cut segments move apart and new bone is formed in the resultant gap. After the required length is achieved and new bone is stabilized, the distractor device is removed subsequently correcting the asymmetry of the face.
This is a powerful tissue engineering technique for generating bone for the desired volume. The overlying soft tissues that are deficient also are expanded, therefore along with the underlying bone deformity, the overlying skin and soft tissue defect is also corrected.
This is the only procedure to increase the size of the jaw bones after the cessation of actual bone growth. For this patient, Dr. Balaji adopted a stage-by-stage rehabilitation. To correct the jaw deformity, he applied the innovative simultaneous maxillary and mandibular distraction procedure wherein new bone is formed in both the upper and lower jaws simultaneously to restore facial symmetry.
Preoperative facial view showing asymmetrical face ( short face on left side)
Slanting bite (occlusal cant) due to retarded development of facial bones on left side
Preoperative 3DCT showing retarded development of maxilla and mandible on left side
After distraction showing symmetrical appearance and elongated genium highlighted in 3DCT scan image
Immediately after fixing the distractor device in position
After completion of distraction and formation of callus at the end of consolidation before distractor removal
3DCT scan showing good new bone formation
Enhanced bone formation following distraction osteogenesis
During distractor removal the genial excess was alos corrected
Excess bone was highlighted
Excess bone was removed
Excess bone removed was used to augment the symphysis on other side
Postoperative facial view showing symmetrical face without any scars on the face
Postoperative occlusal view showing corrected bite
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