Bimaxillary osteodistraction for the treatment of facial asymmetry in adults

Nine patients with hemifacial microsomia or facial asymmetry were treated b etween April 1998 and November 1999. The ages of the patients ranged from 2 1 years to 45 years (mean: 24.6 years); six were female and three were male . The follow-up period ranged from 6 months to 24 months (mean: 15.3 months ). The operative procedure was based on Ortiz Monasterio's simultaneous man dibular and maxillary distraction technique. This technique frees only the pterygo-maxillary junction of the affected side, thereby leaving the nasal septum and the pterygo-maxillary junction of the unaffected side intact. It also uses an external corticotomy on the mandible. In contrast, we modifie d Ortiz Monasterio's method by using a complete LeFort I osteotomy with bot h a complete separation of the pterygo-maxillary junction and a mandibular osteotomy to avoid any resistance during distraction. In one patient with S cleroderma and severe atrophy of the mandible and soft tissue on the right side of the face, a free scapular osteocutaneous flap was used; I month lat er we performed simultaneous distraction of the maxilla and transfer of the scapula bone to the mandible. In one patient with hypoplasia of the zygoma , zygoma expansion was also performed simultaneously. Bidirectional distrac tion was performed in one patient and intraoral devices were applied in thr ee patients. After a latent period of 5 days, distraction was performed at a rate of 1 mm per day. After a consolidation period of 6-8 weeks, the inte rmaxillary fixation and distraction devices were removed. Preoperatively, t he deviation of the occlusal plane ranged from 8 degrees to 13 degrees (mea n: 10.5 degrees); the distraction distance ranged from 7 mm to 17 min (mean : 13 mm). In two patients there was radiologic evidence of relapse 6 months after distraction, but no significant change in facial appearance was obse rved. Seven patients maintained a stable preoperative occlusal relationship and the preoperative lateral open bite was improved postoperatively in two patients. The postoperative occlusal plane was between 0 degrees and 1 deg rees in every case. (C) 2001 The British Association of Plastic Surgeons.