Modified basal osteotomy combined with osteogenic distraction (Hemi-Wing distraction) for correction of facial asymmetry: A new technique

摘要

Complete restoration of facial asymmetry is always difficult to achieve. Facial asymmetry due to growth disturbances of the jaws almost requires orthognathic surgical correction, followed, in many cases, by soft tissue corrections. Mandibular hypoplasia is the earliest skeletal manifestation of Hemifacial microsomy and the clinical defect becomes worse with the time, due to asymmetric growth and secondary midface deformity accompanying. Despite correction of the occlusal plane, facial asymmetry can persist if the mandibular body differs in height. We designed a new technique for skeletal correction of the mandibular basal plane combined with orthognatic surgery that avoided the disadvantages and limitations of other techniques. A 20-year-old male patient with facial asymmetry due to Hemifacial microsomy Type I also requires preoperative orthodontic treatment to align and level their teeth. He showed a 2mm midline shift to the left in combination with a cross bite of the left side. We decide to do a vertical enlargement of the mandibular left border by mandibular Hemiwing osteotomy and unilateral split ramus osteotomy for dental lines alignment with 8 mm of advancement of the hemi - wing genioplasty. Modificated basal osteotomy combined with osteogenic distraction works better than the classic total basal osteotomy with autologous bone graft, if used for the correct indications. We advocate this technique for its efficacy, simplicity, and safety. This technique can be apply for correction of vertical and transverse discrepancies of the mandibular border and combined with sagittal ramus osteotomies for correction of asymmetrical dental lines and oclusal plane.Keywords: Distraction, Hemi-Wing, orthognathic