Fal l 2022 www.nvda.org 11 Featured Article Discussion Any traumatic event in the condylar region in the late postfetal or early postnatal growth can result in the malformation of the facial skeleton associated with tilting of the occlusal plane, deviation of the chin, or an asymmetry of the soft tissues.1 A concern is adjacent osseous involvement of a skeletally immature patient whom is still growing. Treatment planning includes if the pathology can be treated, when to initiate treatment, and the duration of the treatment for both hard and soft tissues. A combination of surgical and orthodontic treatment may be crucial for a good prognosis and stable outcome. Historically, conventional orthognathic surgeries were performed in which there was a high risk of skeletal and soft tissue relapse. This was generally due to the effect of muscular action, such as the pterygomasseteric sling, over the involved osseous structure. The long-term effect of muscular function would overcome any surgical-orthodontic movement with time, resulting in continuing deformities such as changes in vertical dimention.2,3,4 Subsequently, the use of bone grafts came into the play. The treatment planning was done in such a way so as to restore the mandibular dental base to get a good relationship with the maxillary dental base by osteotomy and bone-grafting operations. This treatment included over correction of the deformity at the time of surgery to allow for predicable growth. Still, the results of autogenous bone grafts can be unpredictable 2 and secondary surgical and orthodontic procedures may be required. Distraction osteogenesis can be used to overcome tension in the pterygomasseteric sling by reducing the load on the affected joint.1 In growing patients, distraction osteogenesis when done with distraction vector planning, overcorrection, orthotics, and guiding elastics can correct mandibular symmetry and occlusal canting or the restriction of vertical maxillary growth.5,6,7,8,9 However, the primary concern remains relapse of the treated anatomy over longer periods of time.8 Hence, studies with longer follow-up and in larger patient populations are the current research need. These studies require long-term evaluation to predictably optimally treatment plan. 0 References Gerbino G, Bianchi FA, Verze L, and Ramieri G. Unilateral Mandibular Hypoplasia in Adult Patients: Distraction Osteogenesis and Conventional Osteotomies in a Standardized Sequence. J Craniofac Surg 2014; 25: 00–00. Yamauchi K, Takahashi T. Maxillary distraction osteogenesis combined with mandibular osteotomy to correct asymmetry of the maxillomandibular complex. Plast Reconstr Surg 2006;118:39e–45e Kofod T, Norholt SE, Pedersen TK, et al. Reliability of distraction vector transfer in unilateral vertical distraction of the mandibular ramus. J Craniofac Surg 2005; 16: 15–22. Proffit WR, Turvey TA, Phillips C. Orthognathic surgery: a hierarchy of stability. Int J Adult Orthodon Orthognath Surg 1996; 11: 191–204. Mc McCarthy JG, Schreiber J, Karp N, et al. Lengthening of the human mandible by gradual distraction. Plast Reconstr Surg 1992;89:1–10. Kaban LB, Padwa BL, Mulliken JB. Surgical correction of mandibular hypoplasia in hemifacial microsomia: the case for treatment in early childhood. J Oral Maxillofac Surg 1998;56:628–638. Kofod T, Norholt SE, Pedersen TK, et al. Reliability of distraction vector transfer in unilateral vertical distraction of the mandibular ramus. J Craniofac Surg 2005;16:15–22. Mommaerts M, Nagy K. Is early osteodistraction a solution for the ascending ramus compartment in hemifacial microsomia? A literature study. J Craniomaxillofac Surg 2002;30:201–207. Mulliken JB, Kaban LB. Analysis and treatment of hemifacial microsomia in childhood. Clin Plast Surg 1987;14:91–100. * Dr. Mago is an Oral and Maxillofacial Radiologist (OMR) and an Assistant Professor in Residence in the Department of Clinical Sciences at the UNLV SDM. She obtained an M.S. in Dental Sciences and completed residency training in OMR at the University of Connecticut School of Dental Medicine. She also worked as a faculty member at the University of Iowa. Dr. Mago has completed a Masters in Oral Medicine and Radiology at Maharishi Markandeshwar College of Dental Sciences and Research in India. Dr. Mago holds a specialty license to practice OMR in Nevada. 1 2 3 7 8 9 6 4 5
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