J Korean Assoc Oral Maxillofac Surg.  2011 Dec;37(6):539-544. 10.5125/jkaoms.2011.37.6.539.

Unilateral bimaxillary vertical elongation by maxillary distraction osteogenesis and mandibular sagittal split ramus osteotomy: a case report

• Jung YE
• Yang HJ
• Hwang SJ

• KMID: 2136995
• DOI: http://doi.org/10.5125/jkaoms.2011.37.6.539

Abstract

Maxillary canting and vertical shortening of the unilateral mandibular ramus height is common in cases of severe facial asymmetry. Normally, mandibular distraction osteogenesis (DO) with horizontal osteotomy at the ascending ramus is used for vertical lengthening of the mandibular ramus to correct facial asymmetry with an absolute shortened ascending ramus. In this case report, vertical lengthening of the ascending ramus was performed successfully with unilateral DO and sagittal split ramus osteotomy (SSRO), where the posterior part of the distal segment can be distracted simultaneously in an inferior direction with maxillary DO, resulting in a lengthening of the medial pterygoid muscle. This case describes the acquired unilateral mandibular hypoplasia caused by a condylar fracture at an early age, which resulted in abnormal mandibular development that ultimately caused severe facial trismus. The treatment of this case included two-stage surgery consisting of bimaxillary distraction osteogenesis for gradual lengthening of the unilateral facial height followed by secondary orthognathic surgery to correct the transverse asymmetry. At the one year follow-up after SSRO, the vertical length was maintained without complications.

Keyword

Facial asymmetry; Distraction osteogenesis; Orthognathic surgery; Mandibular fracture

MeSH Terms

Facial Asymmetry
Follow-Up Studies
Mandibular Fractures
Orthognathic Surgery
Osteogenesis, Distraction
Osteotomy
Osteotomy, Sagittal Split Ramus
Pterygoid Muscles
Trismus

Figure

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  Fig. 1. A, D, G. Pre-operative clinical photograph. B, E, H. At Clinical photo taken immediately after the removal of the distraction device, taken at approximately a year and 3 months after the first surgery (left condylectomy, maxillary distraction osteogenesis with Le Fort I osteotomy, and left unilateral sagittal split ramal osteotomy). C, F, I. Clinical photo taken after the second surgery (maxillary Le Fort I osteotomy, bilateral sagittal split ramal osteotomy, and autogenic bone graft using illiac bone) taken 1 year and 7 months after the first surgery, and 2½ months after the second surgery. Young-Eun Jung et al: Unilateral bimaxillary vertical elongation by maxillary distraction osteogenesis and mandibular sagittal split ramus osteotomy: a case report. J Korean Assoc Oral Maxillofac Surg 2011

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  Fig. 2. A. Pre-operative radiograph. B. Radiograph taken immediately after the first surgery. Distraction device was inserted to the maxilla following Le Fort I osteotomy. Left unilateral sagittal split ramal osteotomy was done. Intermaxillary fixation was done, and distraction was initiated. C. Radiograph taken 24 days after the first surgery. The amount of maxillary distraction was 9.5 mm. D. 2½ months after the first surgery. Young-Eun Jung et al: Unilateral bimaxillary vertical elongation by maxillary distraction osteogenesis and mandibular sagittal split ramus osteotomy: a case report. J Korean Assoc Oral Maxillofac Surg 2011

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  Fig. 3. Radiograph taken immediately after the second surgery (maxillary Le Fort I osteotomy, bilateral sagittal split ramal osteotomy, and autogenic bone graft using illiac bone). Young-Eun Jung et al: Unilateral bimaxillary vertical elongation by maxillary distraction osteogenesis and mandibular sagittal split ramus osteotomy: a case report. J Korean Assoc Oral Maxillofac Surg 2011

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  Fig. 4. Clinical photograph taken 3 months after the second surgery. Young-Eun Jung et al: Unilateral bimaxillary vertical elongation by maxillary distraction osteogenesis and mandibular sagittal split ramus osteotomy: a case report. J Korean Assoc Oral Maxillofac Surg 2011

Reference

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