Mandibular Lengthening: Intraoral Distractor
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P.A. Diner, C. Tomat, G. Franchi, H. Martinez, M.P. Vazquez

General Treatment Criteria

The decision to use distraction osteogenesis is based in principle on an orthodontic surgical concept. The treatment plan is drawn from several criteria:

1. Severity of peripheral airway obstruction

Severe peripheral airway obstruction caused by a retroposition of the mandible (Treacher-Collins syndrome, Hanhart syndrome) may require urgent mandibular advancement.

2. Psychological considerations

Psychological evaluation of patients with mandibular hypoplasia is required, especially in cases of craniofacial microsomia. We must be aware of the increased risk for childhood psychosocial difficulties found in these craniofacial abnormalities because these children often feel excluded from everyday school activities.

3. Severity of the hypoplasia

For mild forms of mandibular hypoplasia, orthopedic treatment using functional appliance should be the first treatment option. However, a six month period is sufficient to evaluate the effects of this conservative treatment. Severe forms of hypoplasia, as well as mild forms that do not respond to conservative treatment, may be considered for osteodistraction.

4. Morphological considerations

In cases of congenital and developmental mandibular retrognathia, morphological features that should be considered include a diminished soft tissue contours, deviation of the midline, level of the buccal commissures, and level of the gonial angle on the hypoplastic side. The above findings allow us to include osteodistraction as a treatment option.