Role of Distraction Osteogenesis in the Management of Postankylotic Deformity.

Abstract

Distraction osteogenesis (DO) has evolved in maxillofacial surgery and gained popularity due to the limitations of orthognathic surgery in gross asymmetry cases. The primary aim of the paper was to determine if the use of DO for the management of severe deformities of the mandible secondary to temporomandibular joint ankylosis can achieve optimal results, with or without genioplasty, based on cephalometric norms. The secondary aim of this study was to evaluate the complications associated with DO in this group of patients. Six patients with postankylotic deformity were included. Both internal and external devices were used for an average mandibular corpus lengthening of 15mm with adjunctive procedure genioplasty. All patients had excellent outcome in terms of profile, functional occlusion, and mouth opening without deviation. Two patients had primary genioplasty showed excellent compliance and 2 as secondary at the time of device removal. Complications noted were, difficulty in vector control during distraction, paresthesia, occlusal discrepancy, scarring, and relapse of 2 to 3mm. Preorthodontics and postorthodontics were done in all patients to settle the occlusion, which was stable after 2-year follow-up. Case series shows such gross deformities pose a greater challenge due to undergrowth, gross midline shift, and discrepancy between soft and hard tissue growth pattern and the desired results can be achieved by precise planning. Genioplasty at the time of device placement has definitive positive effect on patient compliance. Though orthognathic surgery has a definitive role in minor deformity, whereas in gross deformities DO with precise planning using 3-dimensional model and vector controlled technique offers excellent outcome.