USE OF MANDIBULAR DISTRACTION OSTEOGENESIS IN ADOLESCENTS AS AN ALTERNATIVE TO ORTHOGNATHIC SURGERY: A CASE SERIES

Abstract

Introduction: Mandibular underdevelopment in adolescents without genetic syndromes is often associated with progressive degenerative changes in the temporomandibular joints (TMJs). This condition leads to pronounced facial asymmetry, occlusal disorders, and aesthetic defects requiring surgical correction. However, conventional orthognathic surgery in patients with incomplete facial skeletal growth is associated with considerable surgical trauma and a risk of recurrence due to subsequent growth. In such cases, distraction osteogenesis is a less invasive, more physiological alternative. Objective: To evaluate the effectiveness of compression-distraction osteogenesis (CDO) using intraoral curvilinear distractors in adolescents with nonsyndromic mandibular hypoplasia, and to determine the feasibility of using CDO as a less traumatic alternative to orthognathic surgery. Methods: Three adolescent patients (two 17-year-old girls and one 16-year-old boy) with asymmetric nonsyndromic mandibular hypoplasia associated with post-arthrotic changes in the TMJs were examined and treated. All patients underwent CDO using Conmet intraoral curvilinear distraction devices (Moscow, Russia). Preoperative planning was performed using three-dimensional computer modeling based on multislice computed tomography (MSCT) data with CranioTools Distraction software (Moscow, Russia; registration certificate RU 2016612081) and analysis of cephalometric radiographs. The dynamics of bone regeneration were monitored using CT and ultrasonography. All patients (and their legal representatives) provided informed consent for the processing of personal data. Results: In all cases, clinically significant lengthening of the mandibular body and ramus was achieved, allowing correction of facial asymmetry and restoration of proper occlusion. The mean increase in mandibular length was 12-16 mm. Follow-up CT showed the distraction regenerate was normotrophic. No patients required subsequent orthognathic surgery, and no complications were recorded during treatment. Conclusion: CDO using intraoral curvilinear distractors is an effective and less traumatic alternative to orthognathic surgery in adolescents with nonsyndromic mandibular hypoplasia. Regular monitoring of the maturing regenerate by CT and ultrasonography makes it possible to individualize the rate of distraction and minimize the risk of complications. Keywords: Distraction osteogenesis, mandible, asymmetry, adolescents, curvilinear distractor, Conmet, orthognathic surgery, clinical case.