Clinical Application of Curvilinear Distraction Osteogenesis for Correction of Mandibular Deformities
Purpose
To report the use of a semiburied curvilinear distraction device, with a 3-dimensional (3D) computed tomography treatment planning system, for correction of mandibular deformities.
Materials and Methods
This was a retrospective evaluation of 13 consecutive patients, with syndromic and nonsyndromic micrognathia, who underwent correction by curvilinear distraction osteogenesis. A 3D computed tomography scan was obtained for each patient and imported into a 3D treatment planning system (Slicer/Osteoplan). Surgical guides were constructed to localize the osteotomy and to drill holes to secure the distractor's proximal and distal footplates to the mandible. Postoperatively, patients were followed by clinical examination and plain radiographs to ensure the desired vector of movement. At end distraction, when possible, a 3D computed tomography scan was obtained to document the final mandibular position.
Results
Of the 13 patients, 8 were females and 5 were males, with a mean age of 11.9 years (range 15 months to 39 years). All 13 underwent bilateral mandibular curvilinear distraction. Of the 13 patients, 8 were 16 years old or younger and 5 were younger than 6 years of age. The diagnoses included Treacher Collins syndrome (n = 3), Nager syndrome (n = 3), craniofacial microsomia (n = 2), post-traumatic ankylosis (n = 1), and micrognathia (syndromic, n = 3; nonsyndromic, n = 1). The correct distractor placement, vector of movement, and final mandibular position were achieved in 10 of 13 patients. In the other 3 patients, the desired jaw position was achieved by “molding” the regenerate.
Conclusions
The use of a semiburied curvilinear distraction device, with 3D treatment planning, is a potentially powerful tool to correct complex mandibular deformities.
⁎Walter C. Guralnick Professor and Chairman, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, MA
†Associate Professor of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, MA
‡Professor of Radiology, Brigham and Women's Hospital, Harvard Medical School, and Director, Harvard Surgical Planning Laboratory, Boston, MA
§Research Fellow, Department of Oral and Maxillofacial Surgery and Harvard Surgical Planning Laboratory, Boston, MA
‖Associate Professor of Oral and Maxillofacial Surgery, Children's Hospital Boston, Harvard School of Dental Medicine, Boston, MA
¶Associate Professor of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, MA
Address correspondence and reprint requests to Dr Leonard B. Kaban: Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Warren 1201, Boston, MA 02114
This work was supported by grants from the AO-ASIF Foundation (Berne, Switzerland), Synthes CMF (West Chester, PA), the Massachusetts General Hospital Center for Innovation and Minimally Invasive Therapy in Medicine, the Massachusetts General Hospital Department of Oral and Maxillofacial Surgery Education and Research Fund, and National Institutes of Health grant P41RR13218 (R. Kikinis, principal investigator).
ABSTRACT