Transsutural Distraction Osteogenesis Versus Osteotemy Distraction Osteogenesis

Abstract

The technique of transsutural distraction osteogenesis (TSDO) rendered a new and minimally invasive alternative for midfacial advancement. Many topics addressed the osteotomy distraction of the midface; we know less, however, about the destiny of the advanced midface by transsutural distraction. Long-term results of 20 patients with midfacial hypoplasia treated by either TSDO or osteotomy distraction osteogenesis (ODO) were investigated clinically, cephalometrically, and statistically. The follow-up period ranged from 4 to 10 years, and radiographic analysis, inpatient duration, whole length of treatment, times of outpatient treatment, and surgical morbidity were assessed. Nine patients were treated by the technique of TSDO, with a mean follow-up of 5.2 years (range, 4-8 years), and 11 by Le Fort III osteotomy distraction, with a mean follow-up of 6.4 years (range, 4-10 years). In TSDO group, the mean angle of SNA was 74.4 degrees preoperatively, 81.6 degrees immediately after distraction, 81.7 degrees at 6 months postoperatively, and 81.8 degrees in 4- to 8-year postoperative period. In ODO group, the mean angle of SNA was 74.0 degrees preoperatively, 85.3 degrees immediately after distraction, 83.2 degrees at 6 months postoperatively, and 83.1 degrees in 4- to 10-year postoperative period. In TSDO group, the mean advancement of anterior nasal spine-pterygomaxillary fissure length was 5.5 mm immediately after distraction, 0.03 mm at 6 months postoperatively, and 0.4 mm in 4- to 8-year postoperative period, resulting in no statistically significant retrusion; in ODO group, the mean advancement of anterior nasal spinepterygomaxillary fissure length was 12.2 mm immediately after distraction, which decreased 2.5 mm at 6 months postoperatively and 2.5 mm in 4- to 10-year postoperative period, resulting in retrusion rate of about 20%. The patients in ODO group had longer inpatient duration, and 1 patient had an inharmonious forward movement manifested nasal root prominence and medial canthal alteration. Those in group TSDO had a longer process of treatment and more times of outpatient manipulation. The technique of TSDO is effective, minimally invasive, and aesthetically optimal for early correction of midfacial hypoplasia of the growing children, and the technique of ODO can be used successfully for hypoplastic midface of the adults. The most postoperative retrusion appeared in the first 6 months, and no statistically significant retrusion occurred in growing patients.