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Researchers create treatment algorithm for orthognathic surgery in craniofacial microsomia

Researchers established a surgical treatment algorithm for orthognathic surgery based on 15 patients with craniofacial microsomia from the practice of lead researcher, Rodrigo Farina, DDS, Med.

The surgical treatment is mostly based on skeletal correction, which, historically is completed after growth has finished.

Certain advantages, however, have been detected in early-stage surgical correction, such as improved growth potential by improving the functionality of the affected structures, minimizing secondary alternatives from the limited growth of the adjacent structure and improving patients’ aesthetic appearance and socialization, according to researchers.

Conventional orthognathic surgery is indicated for patients who have completed craniofacial growth and development and a reconstructed mandibular ramus or a slight severity exists, according to the study.

Mandibular distraction osteogenic (MDO) and deferred orthognathic surgery is appropriate when a mandibular remains, which allows the MDO to be undertaken and an osteotomy of the mandibular ramus is completed to lengthen the ramus.

In cases of MIIA, the vector is planned according to the treatment objectives with regard to the decanting of the occlusal plane, the leveling of mandibular angles, centering of the dental midline, and centering of the chin, according to researchers.

In MIIB and MIII, the distraction vector is planned in the direction where the new temporomandibular joint will be established. Once the occlusal plane is leveled, the consolidation period is anticipated. The distraction device is then removed and a Le Fort I maxillary decanting osteotomy with mandibular self-rotation is performed concurrently.

For patients with bilateral craniofacial micromasia (CFM), distraction is completed until the desired bilateral mandibular ramus is elongated and the Le Fort I osteotomy and mandibular self-rotation are undertaken at the same time as removing the distractor, according to researchers.

Reconstruction of mandibular ramus and orthognathic surgery in one surgery can take place if the mandibular ramus remainder is insufficient for MDO (MIIB, MIII) after craniofacial growth, orthognathic surgery is undertaken at the same time as reconstruction of the TMJ and the compromised mandibular ramus, by a free graft of the iliac crest, an articular TMJ prosthesis or a fibula flap.

“[These] are complex patients with a 3-dimensional deformation, meaning that is fundamental that they undergo multidisciplinary treatments according to protocols that must be based on the degree of severity, the level of skeletal maturity, age, and patients’ psychological needs,” the researchers concluded. –by Abigail Sutton

Disclosures: The researchers reported no financial disclosures.