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.
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.
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