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Contemporary Review | Journal Club

Mandibular Osteotomies and Distraction Osteogenesis Evolution and Current Advances

Masoud Saman, MD; Jason M. Abramowitz, BA; Daniel Buchbinder, DMD, MD
JAMA Facial Plast Surg. 2013;15(3):167-173. doi:10.1001/jamafacial.2013.44.
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Importance Although a number of mandibular and occlusal problems may be addressed by orthodontic treatment alone, dentofacial osteotomies are often needed to achieve desired functional or cosmetic results. With the increased popularity of mandibular distraction osteogenesis in recent years, the role of the facial plastic and reconstructive surgeon is crucial in the multidisciplinary care of patients with such problems.

Objective To review the history and evolution of mandibular osteotomies and distraction osteogenesis and to discuss indications, advantages, disadvantages, and recent advances of these techniques.

Evidence Review MEDLINE and PubMed searches without date limits, confined to publications in English, German, and French languages were used to search for terms mandibular advancement, mandibular osteotomy, orthognathic surgery, mandibular distraction osteogenesis, prognathism, and retrognathism in the respective languages. References not found on the sources noted were found in print form in the New York Medical College Library when needed. Particular techniques, as originally described or relating to mandibular osteotomies and mandibular distraction osteogenesis, were critically reviewed.

Findings The goal of surgical mandibular modification procedures is to correct a variety of craniofacial abnormalities for both functional and aesthetic purposes. Multiple techniques of both mandibular osteotomy and distraction osteogenesis have been shown to be effective. Their effectiveness and utility is primarily determined by the specific craniofacial defect and desired outcome, as well as surgeon preference and patient compliance.

Conclusions While mandibular osteotomy has evolved tremendously, distraction osteogenesis continues to grow as a leading method of surgical correction for a variety of craniofacial defects. Current research shows significant strides in making distraction more effective and efficient to use for both the surgeon and the patient. With the growing popularity of these procedures, the up-to-date knowledge of the facial plastic and reconstructive surgeon in these advances is of utmost importance.

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Figure 1. Schematic illustration of mandibular ramus sagittal split osteotomy, the most common technique for mandibular advancement. The arrows indicate the direction in which the mandible will be mobilized after osteotomy. Reprinted with permission from Continuum Health Partners.

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Figure 2. Schematic illustration of operative planning for mandibular ramus sagittal split osteotomy in a retrognathic patient with malocclusion. The arrow indicates the direction in which the mandible will be mobilized after osteotomy. Reprinted with permission from Continuum Health Partners.

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Figure 3. Schematic postoperative illustration of mandibular advancement using sagittal split osteotomy and restoration of correct occlusion. Reprinted with permission from Continuum Health Partners.

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Figure 4. Inadequate airway in micrognathic infant. A, Preoperative view. B, Post–mandibular distraction increase in airway diameter obviating need for tracheostomy in this patient. Reprinted from Abramson et al36 with permission from Elsevier Ltd. Solid lines indicate the pharyngeal airway diameter at the level of the soft palate; dotted lines, pharyngeal airway diameter at the level of the base of the tongue. www.sciencedirect.com/science/journal/02782391.

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Figure 5. Ramus distractor device. Image courtesy of KLS Martin Group USA, reprinted with permission.

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