Devices & Techniques: Intraoral Distraction
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The bendable nature of the device arms allows intraoperative adaptation of the appliance, which minimizes the possibility of mandibular nerve damage due to screw placement. In addition, the device can be removed following the consolidation period by cutting the metal arms and pulling the forked ends of the appliance, leaving the fixation screws in the bone.

In 1997, Bell and Guerrero presented their results of distraction osteogenesis on 120 patients with ages ranging from 6 to 38 years (Bell & Guerrero, 1997b). Where a bilateral transverse deficiency was present, symphyseal distraction was accomplished. If a unilateral transverse discrepancy was evident, unilateral parasymphyseal distraction was performed. In cases of severe anterioroposterior hypoplasia not correctable with a sagittal split osteotomy, the goal was to gain length in the corpus. In cases of hemifacial microsomia and ramus hypoplasia, the object was to obtain an increase in ramus height. All patients obtained significant mandibular lengthening (average of 9.2 mm) and proper dental alignment.

FIG. 3.3.18-3.3.20. Bending (left), cutting (center), and crimping (right) of the DynaForm Intraoral Distractor (Stryker Leibinger, Kalamazoo, MI, USA) to adapt the appliance for midsymphyseal mandibular widening.

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