Tratamiento quirúrgico ortodóncico de microsomía hemifacial mediante elongación ósea intraoral de rama mandibular

Abstract

Dentofacial deformities have increased in frequency in oral and maxillofacial surgeons practice. This group of deformities are related with bone and dental structures in any of three spacial planes: vertical. sagital and tranverse or a combination of all them. Mandibular hypoplasia is one of the most common problems dentists have to face. Complexity arises when the asymmetry becomes more evident as patient grows, with laterognatia and chin deviation, cross bite and posterior open bite; these problems are counteracted by an occlusal plane deviation, resulting in functional and esthetic abnormalities. Bone elongation in hypoplasic mandibles is a technique that produces notable changes in bone as well as soft and vascular tissues in a brief period of time, without the need of complex surgical procedures; allowing treatment at its early stages. This paper presents 9 cases of facial asymmetry due to hemifacial microsomia treated by osteogenic elongation of mandibular ramus. Clinical features and pictures, simple cranial views (posteroanterior and lateral), panoramic view and computerized tomography with three-dimensional scan were evaluated. All cases were treated by mandibular ramus osteogenic elongation under general anesthesia, with favorable esthetic and functional outcomes, resulting in stable occlusion and facial symmetry, with minimum complications such as temporomandibular pain, temporary chin paresthesia, posterior open bite and anterior cross bite. Compensatory maxillary growth was noted, being necessary pre and postsurgical orthodontic treatment. All cases were successful, having control follow ups from 6 months to 2 years. No recurrence or other complications were present.