Journal List > J Korean Assoc Oral Maxillofac Surg > v.37(6) > 1032517

J Korean Assoc Oral Maxillofac Surg. 2011 Dec;37(6):539-544. Korean.
Published online December 27, 2011.  https://doi.org/10.5125/jkaoms.2011.37.6.539
Copyright © 2011 by The Korean Association of Oral and Maxillofacial Surgeons
Unilateral bimaxillary vertical elongation by maxillary distraction osteogenesis and mandibular sagittal split ramus osteotomy: a case report
Young-Eun Jung, Hoon Joo Yang and Soon Jung Hwang
Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University Dental Hospital, Dental Research Institute, BK21 for Craniomaxillofacial Life Science, Seoul National University, Seoul, Korea.

Corresponding author: Soon Jung Hwang. Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, 28 Yeongeon-dong, Jongno-gu, Seoul 110-749, Korea. TEL: +82-2-2072-3061, FAX: +82-2-766-4948, Email: sjhwang@snu.ac.kr
Received August 17, 2011; Revised October 12, 2011; Accepted November 22, 2011.

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.

Keywords: Facial asymmetry; Distraction osteogenesis; Orthognathic surgery; Mandibular fracture

Figures


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.
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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.
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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).
Click for larger image


Fig. 4
Clinical photograph taken 3 months after the second surgery.
Click for larger image

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