Jaw Distraction Before & After Case 1
Jaw distraction surgery is used when the amount of movement is too large for a single surgery.
In this case, a patient with Crouzon syndrome planned for dental restoration. The upper and lower jaws were much more than 10mm offset, which is the usual cutoff to consider distraction surgery.
A 3D-printed model and guides were used for precisely planning the placement of the osteotomies, plate positioning, and the vector of distraction.
The use of internal distractors avoided the use of a large, external halo device. No external scars, wires, or screws were needed.
After placement of the hardware, the upper jaw was advanced a little every day until we reached our goal of lining up the upper and lower jaws.
The patient is seen here after the bone has solidified, and the distractors have been removed.
You can see an improvement of her facial profile and balance, with the upper lip now better supported as well.
The posts for dental implants were able to be placed at the time of distractor removal as well.
We can’t wait to see her final results!
Jaw Distraction Before & After Case 2
Treacher-Collins syndrome affects about one in every 50,000 children, and varies widely in severity from one patient to another.
There is underdevelopment of the cheeks and jaws. This affects the shape and size of the orbits, cheeks, and jaws.
For this patient, the small lower jaw made her airway too small for her breathing needs. Her tracheostomy site was unable to heal because of this, despite a previous jaw distraction.
3D modeling and planning was performed to give the best chance at protecting her tooth buds and nerves, while having enough solid fixation to grow new bone, pushing her jaw forward in the process.
Over a couple of weeks, the mandible was moved out a millimeter at a time.
The hardware has since been removed, with good bone healing.
We look forward to having her tracheostomy removed and healed soon!
Jaw Distraction Before & After Case 3
The smile says it all!
About 1 in 3 patients with cleft lip and palate benefit from jaw surgery. Aligning the upper and lower teeth helps people fully chew their food, and reduces wear and tear on the TMJ’s.
We also consider facial balance and harmony when planning the surgery and final outcome.
Jaw surgery can often be done in a single surgery, sometimes involving just the upper jaw, and sometimes with the lower jaw as well.
Here, the amount of advancement was well over 10mm, which is the point at which we usually move towards distraction over a single surgery.
Distraction involves cutting the bone and freeing up scar tissue, but then gradually moving from the starting position by 1mm per day.
New bone is deposited in the space made as the upper jaw moves forward. The surrounding blood vessels, lining, and old scar tissue all expand and accommodate the new bony position.
We usually keep the hardware in place (much more comfortably after finishing advancement!) for 3 months while the new bone hardens.
At that point, minor adjustments can be made as needed with additional movement or augmentation, or just removal of the hardware.
Here, we performed some fat grafting to the upper lip, expecting about half of the fat to reabsorb and half to stay long term.
He is seen here at about a month after that surgery — we look forward to sharing more photos as all the swelling comes down!
Jaw Distraction Before & After Case 4
The timing and techniques used for our patients with clefts are tailored to each patient.
Here, the upper jaw required greater than 10mm of advancement to correct his occlusion.
Thus, we performed a Le Fort 1 internal distraction: the maxilla was mobilized, and hardware placed to gradually bring the bone and teeth forward 0.5mm at a time.
This incremental movement stretches the scar tissue, blood vessels, and nerves, giving them a chance to catch up a little bit every day and adapt. Otherwise, the advancement in a single surgery can be limited, and the maxilla is at risk of collapsing back.
Once the new bone solidifies, we return to retrieve the hardware and double-check stability of the new bone.
Here, he had continued difficulty breathing through his nose, and desired improved symmetry and contour.
Given his ongoing nasal obstruction — a closed septorhinoplasty was performed at the same time as the hardware removal.
MTF rib cartilage was used as a dorsal onlay graft, cantilevered with a septal extension graft. Tip grafts and diced cartilage helped provide some further tip definition and contour.
He is healing wonderfully at one month, with the swelling already much improved.