This is a case of facial asymmetry caused by developmental abnormality -- Hemifacial Microsomia that cause smaller lower jaw as seen in the 3D CT. The entire half of the corpus of mandible is smaller. The surgery need to be performed through intraoral approach. The aim will be to lengthen the mandible in the affected side; simultaneously by Le fort 1 maxillary osteotomy to correct the occlusal cant.
After raising the flap and visualizing the smaller side of the mandible, the distractor was adapted to the bone. The placement site was determined and mock placements were performed on the bone. Guiding screw holes were placed so that distractors could be placed as previously determined. The active arm was decided to be placed through a hole created in neck. This placement ensures convenient vector, ease of operation, minimum discomfort as well as no instance of distractor arm breakage. After this step, the mandible was cut along the predetermined line. Refit of distractors at previously decided site was done and secured. Distractors was checked. One complete turn ensured lengthening of 0.5mm.
After this, standard maxillary Le fort 1 surgery was done on the affected side. Pterygoid dysjunction was performed only on the affected side. Inter Maxillary Fixation was performed. Appropriate hinge screws and wireloops were placed. The incisions were closed. On operating the distractor, both the maxillomandibular corrections was ensured. After consolidation, asymmetry was corrected.
After raising the flap and visualizing the smaller side of the mandible, the distractor was adapted to the bone. The placement site was determined and mock placements were performed on the bone. Guiding screw holes were placed so that distractors could be placed as previously determined. The active arm was decided to be placed through a hole created in neck. This placement ensures convenient vector, ease of operation, minimum discomfort as well as no instance of distractor arm breakage. After this step, the mandible was cut along the predetermined line. Refit of distractors at previously decided site was done and secured. Distractors was checked. One complete turn ensured lengthening of 0.5mm.
After this, standard maxillary Le fort 1 surgery was done on the affected side. Pterygoid dysjunction was performed only on the affected side. Inter Maxillary Fixation was performed. Appropriate hinge screws and wireloops were placed. The incisions were closed. On operating the distractor, both the maxillomandibular corrections was ensured. After consolidation, asymmetry was corrected.
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