New approach for the surgico-orthodontic treatment of hemifacial microsomia.

One of the important clinical findings in hemifacial microsomia (HFM) is facial asymmetry (FA) with unilateral underdevelopment and malformation of the mandible and/or maxilla. Unilateral distraction osteogenesis (UDOG) of the mandible has been used for correction of FA in HFM patients. However, return to the original FA status often occurs because of contraction of the distracted bony segment of the mandible and insufficient compensatory downward growth and skeletal midline correction of the maxilla on the affected side. Although bimaxillary UDOG procedure in the maxilla with Le Fort I osteotomy and the mandible with ramus osteotomy was suggested as an alternative treatment modality, it has some disadvantages including elongation of the face, inaccuracy of vector control, and less predictable results. Occlusal plane canting, skeletal midline deviation of the maxilla, and unilateral mandibular hypoplasia might be simultaneously corrected by fixation of the maxilla into a proper position after Le Fort I osteotomy and UDOG of the mandible. Three-dimensional virtual simulation using three-dimensional computed tomography data could help to accurately predict surgical outcomes. In addition, transarch elastic traction from the orthodontic mini-implants on the unaffected side of the mandible to the maxillary posterior teeth on the affected side can produce a plastic molding of the regenerated bone in the distraction area of the mandible and induce compensatory dentoalveolar downward development of the maxillary posterior teeth. Therefore, the purpose of this article was to introduce a new approach for the surgico-orthodontic treatment consisting of simultaneous maxillary fixation and unilateral mandibular distraction with transarch elastic traction in HFM patients.