9.5\ Mandibular Distraction

9.5.1\ Discussion

Mandibular distraction devices are used for mandibular bone lengthening to treat both posttraumatic deformities and congenital mandibular deficiencies. The devices are available as single (Fig. 9.8) versus multivector/curvilinear (Fig. 9.9) and internal versus external designs. In addition, transport distractors can be used to shift bone fragments anteriorly or posteriorly (Fig. 9.10). The devices are usually composed of stainless steel or

a

titanium and are therefore radiopaque and can be adjusted from the exterior. The devices are attached to the mandible after mandibular osteotomy has been performed. The goal of this technique is to promote gradual bone growth (osteogenesis) across the gap created by the corticotomy and distraction. Bone growth, alignment, and most complications can be evaluated via radiographs or CT. Complications of mandibular distraction osteogenesis include relapse, tooth injury, hypertrophic scarring, nerve injury, infection, inappropriate distraction vector, device failure, fusion error, and temporomandibular joint injury.

b

Fig. 9.8  Single-vector distraction device. The child has a history of congenital right mandibular deficiency. Scout (a) and 3D CT (b) images demonstrate a single-vector

right mandibular device in position, which spans the osteotomy­ gap in the mandibular ramus