This is a case of 22 year   female patient   who reported to us for prosthetic rehabilitation of her lower jaw.  She is a diagnosed case of ectodermal dysplasia with complete anodontia of lower arch and partial anodontia of the upper arch. CT scan demonstrating the edentulous atrophic mandible.

We can see the mental foramen along the superior border of the mandible.  The dental rehabilitation of the patient was planned using implants for which adequate alveolar height   is required. Hence alveolar distraction of the symphyseal region was planned. Under nasoendotracheal intubation,  crestal incision was placed from 36 to 46 region and full thickness flap reflected. The mental nerve was identified and carefully protected. Horizontal osteotomy cut was marked along the buccal cortex and the vertical osteotomy cut is marked  above the mental nerve.  Distractor device positioned and fixed.  Osteotomy   is then completed along the lingual cortex. The device is checked by distracting the segments.  Wound closure done. Patient  extubated, recovery spontaneous and uneventful. 

This is a case of a 22 year old male patient who reported to us 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 madibular deficiency at the ramus level and deficiency measured almost 17mm with a resultant occlusal cant. Hence a maxillomandibular distraction was planned using internal distraction osteogenesis to lengthen the ramus and to correct the occlusal cant as well.   

Under nasoendotracheal intubation, general anaesthesia was induced.  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. Reflection of the lingual tissues done minimally to protect the inferior alveolar nerve. Horizontal osteotomy done inferior to the anti lingula over the buccal cortex. The direction of the osteotomy cut and positioning of the distractor is the most important as it determines the vector of distraction.  The vector determines the direction of the bone growth. The distractor device positioned and fixed using screws. Osteotomy is then completed along the medial cortex. Distractor device checked and wound closure done. Le Fort I osteotomy completed in maxilla. Patient extubated, recovery spontaneous and uneventful.  After a latency period of 5 days, IMF was done and distraction at the rate of 1 mm per day was accomplished. Over correction of about 21 mm was done so as to compensate for any relapse that may occur. The post-operative CT image demonstrating the correction achieved.

This is the 2nd stage of the ear reconstruction. In the previous stage of reconstruction, the cartilagenous grafts were harvested carved and they were banked in the donor site. Additional, excess cartilages were also banked in the site, which would be latter serve as stops.

After adequate healing, in this 2nd stage, the inserted cartilagenous graft was identified. Clear, precise incision to simulate the pinna outline was drawn. Using careful elevation, and use of excess cartilageal blocks, the reconstructed pinna was lifted and positioned. Pericranial tissues have to be left intact and adequate care need to be exercised. This elevated flap was debulked to resemble the normal external pinna.  Resorbable sutures were carefully placed to simulate the rolled margins. The defect left behind has to be closed – either by a temporal flap or a similar approach. In the present case, simultaneously, a full thickness graft was raised from the groin region. Excess fat tissues and adnexial structures were carefully removed. The donor site was closed in layers. This full thickness graft was then carefully placed and sutured accordingly in layers.

This step results in a successful creation of 3D soft tissue contour. Later in the 3rd step, the lobule of the pinna will be repositioned to complete the ear reconstruction