Early Mandibular Distraction Reduces Relapse In Orthognathic Surgery For Craniofacial Microsomia
Anthony A. Bertrand, MD, MBA, Brian N. Dang, BS, Allison C. Hu, BA, Candace H. Chan, BS, Justine C. Lee, MD, PhD.
University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA.
PURPOSE: Approaches to reconstructing mandibular hypoplasia in craniofacial microsomia (CFM) are divided among craniofacial surgeons. While some subscribe to a two-stage correction with mandibular distraction, frequently during childhood, followed by orthognathic surgery, others advocate for a single-stage definitive orthognathic procedure at skeletal maturity. However, final orthognathic outcomes of one-stage versus two-stage methods have not been thoroughly evaluated. In this work, we evaluated relapse following orthognathic surgery in CFM patients treated with and without prior mandibular distraction.
METHODS: CFM patients with Pruzansky type II or III mandibular hypoplasia (n=50, age 24.5±7.4 years) treated with mandibular distraction (n=29, 58.0%) or without (n=21, 42.0%) were compared for orthognathic surgery requirements, type of orthognathic surgery, and relapse after orthognathic surgery at skeletal maturity. Statistical analyses were performed using Chi square, Fisher’s exact, Kruskal-Wallis, and Mann-Whitney U tests.
RESULTS: No significant differences were found in gender, severity, bilaterality, syndromic diagnosis, or requirement for orthognathic surgery (57.1% versus 58.6%, respectively) between CFM patients treated with one- versus two-stage methods for mandibular reconstruction. Among the patients who received orthognathic surgery at skeletal maturity (mean followup 10.4±8.7 years), 50% of patients treated with onestage mandibular reconstruction demonstrated relapse while none of the patients treated with a two-stage approach of mandibular distraction followed by orthognathic surgery demonstrated relapse (p=0.02).
CONCLUSION: A two-stage approach to mandibular reconstruction in CFM patients with mandibular distraction followed by orthognathic surgery at skeletal maturity results in a lower relapse rate compared to a one-stage technique.
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