No Dissection Mandibular Distraction.

摘要

To present an initial series of patients treated using a novel technique for mandibular distraction utilizing a custom-fabricated, nonburied distractor and minimal soft tissue dissection which may offer advantages over conventional open techniques.Based upon a series of prototypes, we have introduced a new mandible distractor and technique which was successfully used to distract 8 micrognathic patients. The device consists of an activation rod affixed to distally to a locking plate which is adapted to the soft tissue adjacent to the coronoid. The activation rod sits in the buccal space. Anteriorly, it is affixed to a locking plate which lies extramucosally in the oral-buccal sulcus. The device is fixed to the coronoid and menton by permucosally-fired locking screws, followed by ultrasonic angle osteotomy. Through a stab at the oblique ridge, a micro-tipped ultrasonic osteotome is used to perform the osteotomy from within the medullary space of the mandible, avoiding any degloving of the soft tissue. The device is then activated in the conventional fashion. Distraction is performed at 3 mm daily to avoid premature consolidation, which appears to be more common due to enhanced callus production. The device is then left in place during consolidation. Removal is performed by simply unscrewing the locking screws and removing the device in 3 pieces. There is no soft tissue dissection required. A variant of the anterior plate permits limited dissection to minimize the profile of the plate in the sulcus.