Simultaneous maxillo-mandibular distraction in early adolescence as a single treatment modality for durable correction of type II unilateral hemifacial microsomia: Follow-up till completion of growth

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• 作者：Ting-Chen Lu<sup>asup><sup> ; sup><sup>bsup> ; Gavin Chun-Wui Kang<sup>asup><sup> ; sup><sup>csup> ; Chuan-Fong Yao<sup>asup><sup> ; sup><sup>bsup> ; Eric Jein-Wein Liou<sup>dsup> ; Ellen Wen-Ching Ko<sup>dsup> ; Zung-Chung Chen<sup>asup><sup> ; sup><sup>bsup> ; Philip Kuo-Ting Chen<sup>asup><sup> ; sup><sup>philip@cgmh.org.tw" class="auth_mail" title="E-mail the corresponding authorsup>
• 关键词：Craniofacial microsomia ; Distraction osteogenesis ; Separate mandibular and maxillary distractors ; Early distraction ; Long-term results
• 刊名：Journal of Cranio-Maxillofacial Surgery
• 出版年：2016
• 出版时间：September 2016
• 年：2016
• 卷：44
• 期：9
• 页码：1201-1208
• 全文大小：1692 K

文摘

Timing of surgical intervention in hemifacial microsomia (HFM) is controversial. Although mandibular osteodistraction in childhood for HFM is popular, recent data for single-stage distraction in growing HFM patients demonstrated long-term relapse. Literature suggests that adolescents in the late mixed dentition age or permanent dentition age (11–16-year-old) had more stable outcomes post-distraction than younger children. We present favorable experience using single-treatment simultaneous maxillo-mandibular distraction in early adolescent Pruzansky–Kaban type II HFM patients.

Methods

This was a retrospective longitudinal study of seven consecutive type IIa/b HFM growing patients (12–16-year-old) treated with simultaneous maxillo-mandibular distraction. Oral commissure cant was photographically measured preoperatively and at 6 months and annually ranging 3–7 years post-distraction. Ramus height and chin deviation were measured from radiographs done preoperatively and at distractor-removal, 1 year, 2 years, and 4 years post-distraction.

Results

Average age at osteodistraction and at latest follow-up was 13.7 and 18.6 years, respectively. Improvement was significant (p < 0.05) and sustained for mean oral commissure cant (5.1°–0.41°), mean ramus height ratio (0.59–0.86), and average chin deviation (15.9 mm–1.2 mm). Two subjects had mandibular branch palsy and one had mild pin-tract infection – all resolved. All were satisfied with their facial appearance.

Conclusion

We have demonstrated good lasting outcomes at completion of growth with single-stage simultaneous maxillo-mandibular distraction for type II HFM adolescents in the late mixed-dentition or older age, and advocate this as an alternative to osteodistraction or orthognathic surgery upon skeletal maturity.