Maxillary-driven simultaneous maxillo-mandibular distraction for hemifacial microsomia

Hideo Nakajima, Yoshiaki Sakamoto, Ikkei Tamada, Hisao Ogata, Kazuo Kishi, Teruo Sakamoto

Research output: Contribution to journalArticlepeer-review

13 Citations (Scopus)


We treat hemifacial microsomia with a combination of surgery and orthodontic treatment during the growth period, resulting in early improvement in facial asymmetry and the induction of normal growth. We previously used gradual distraction of the mandibular ramus for Pruzansky's type II classification (Pruzansky, 1969). In type II cases, the maxilla should also be treated actively as, using this technique, improvement of the occlusal plane is difficult to achieve, resulting in a cross bite and difficulties in post-operative orthodontic treatment - especially in older patients. Morphologically, the mandibular angle region of the operative side is flat, and the angle of the mouth remains elevated. We performed mandibular-driven simultaneous maxillo-mandibular distraction while the occlusion was maintained using intermaxillary anchorage. However, mandibular-driven distraction tended to elongate the face because the mandible only elongated downwards and the mandibular ramus did not reach the glenoid. Furthermore, external distraction devices produce significant distress for patients until removal of the device and cause scars on the face. We developed a new internal distraction device with a variable angle and performed maxillary-driven simultaneous maxillo-mandibular distraction using this device. The result was morphologically satisfactory and solved the above problems. Because the patient was in the growth period, careful follow-up and induction to normal growth were important while the inferior growth of the affected side was monitored.

Original languageEnglish
Pages (from-to)549-553
Number of pages5
JournalJournal of Cranio-Maxillofacial Surgery
Issue number8
Publication statusPublished - 2011 Dec


  • Distraction osteogenesis
  • Hemifacial microsomia
  • Internal distraction device
  • Simultaneous maxillo-mandibular distraction

ASJC Scopus subject areas

  • Surgery
  • Oral Surgery
  • Otorhinolaryngology


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