2001 Volume 11 Issue 1 Pages 58-62
Severe facial asymmetry with a large occlusal transverse cant is difficult to treat by usual orthognathic surgery. Postoperative relapse is associated with severity of the facial asymmetry. Relapse has been correlated to the amount of surgical movement. This is thought to be related to the sudden repositioning and stretching of the masticatory muscles and perimandibular soft tissues. Overcoming soft tissue adaptation capability can be avoided by means of gradual traction.
Distraction osteogenesis of the mandible for treatment of hemifacial microsomia in children is a wellestablished surgical procedure. However, in adults, mandibular distraction osteogenesis presents the disadvantage of post-surgical malocclusion that complicates the postsurgical orthodontic treatment. To avoid this problem and improve facial symmetry, simultaneous distraction of the maxilla and mandible has been proposed by other authors.
We report a case of a 24-year-old female with severe facial asymmetry that was treated by simultaneous mandibular and maxillary lengthening using distraction osteogenesis. A High Le Fort I osteotomy was performed simultaneously with a unilateral ascending mandibular ramus osteotomy. Distraction was carried out after a seven-day latency period, at a rate of 1.0mm/day. The patient was on intermaxillary fixation during the latency and distraction phases. The hardware was removed after three months of consolidation. After two years of follow-up, no relapse has been observed. This technique proved adequate and stable for the treatment of severe facial asymmetries.
