Korean J Orthod.  2020 Mar;50(2):136-144. 10.4041/kjod.2020.50.2.136.

Growth observation and orthodontic treatment of a hemifacial microsomia patient treated with distraction osteogenesis

• Chung NH
• Yang SJ
• Kang JY
• Jeon YM
• Kim JG

• KMID: 2471874
• DOI: http://doi.org/10.4041/kjod.2020.50.2.136

Abstract

Hemifacial microsomia (HFM) patients may experience emotional withdrawal during their growth period due to their abnormal facial appearance. Distraction osteogenesis at an early age to improve their appearance can encourage these patients. Some abnormalities of the affected side can be overcome by distraction osteogenesis at an early age. However, differences in the growth rate between the affected and unaffected sides during the rest of the growth period are inevitable due to the characteristics of HFM. Therefore, re-evaluation should be performed after completion of growth in order to achieve stable occlusion through either orthognathic surgery or camouflage orthodontic treatment. An eight-year-old patient visited the clinic exhibiting features of HFM with slight mandibular involvement. He received phase I treatment with distraction osteogenesis and a functional appliance. Distraction osteogenesis was performed at the right ramus, which resulted in an open bite at the right posterior dentition. After distraction osteogenesis, a functional appliance and partial fixed appliance were used to achieve extrusion of the affected posterior dentition and settlement of the occlusion adjustment on the unaffected posterior dentition. The patient visited the clinic regularly for follow-up assessments, and at the age of 20 years, he showed facial asymmetry of the mandible, which had deviated to the right side. He received orthodontic treatment to improve the occlusion of his posterior dentition after the growth period. Without orthognathic surgery, stable occlusion and a satisfactory facial appearance were obtained through camouflage orthodontic treatment.

Keyword

Distraction osteogenesis; Hemifacial microsomia

MeSH Terms

Dentition
Facial Asymmetry
Follow-Up Studies
Goldenhar Syndrome*
Humans
Mandible
Open Bite
Orthognathic Surgery
Osteogenesis, Distraction*

Figure

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  Figure 1 First phase pretreatment facial photographs.

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  Figure 2 First phase pretreatment 3-dimensional dental models.

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  Figure 3 First phase pretreatment. A, Lateral cephalogram; B, panoramic radiograph; C, posteroanterior cephalogram; D, computed tomography image.

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  Figure 4 Panoramic radiograph obtained after termination of activation.

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  Figure 5 Facial photographs obtained before and after activation.

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  Figure 6 Functional appliance used after distraction, containing a unilateral posterior bite block on the left side to allow extrusion of the right posterior teeth.

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  Figure 7 Partial fixed appliance and vertical elastics used to extrude of the right posterior teeth after consolidation period. A bite block was bonded with glass ionomer cement on the lower left posterior teeth.

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  Figure 8 First phase posttreatment facial photographs.

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  Figure 9 First phase posttreatment 3-dimensional dental models.

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  Figure 10 Second phase pretreatment facial and intraoral photographs.

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  Figure 11 Second phase pretreatment. A, Panoramic radiograph; B, posteroanterior cephalogram; C, lateral cephalogram.

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  Figure 12 Second phase treatment progress.

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  Figure 13 Second phase posttreatment facial and intraoral photographs.

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  Figure 14 Superimposition of the second phase pretreatment (blue) and posttreatment (red) lateral cephalometric tracings.

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  Figure 15 Panoramic radiographs from first phase to second phase treatment. A, 8 years and 11 months, before distraction osteogenesis; B, 9 years and 7 months, after distraction osteogenesis; C, 10 years and 7 months; D, 12 years and 6 months; E, 15 years and 4 months; F, 20 years and 9 months.

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