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Mandibular Distraction and Long-Term Dental Morbidity
Wendy Chen
Jack E. Brooker
Joshua M. Barnett
Justine Kim
Jesse A. Goldstein
Joseph E. Losee
Lindsay Schuster
University of Pittsburgh
2018-01-30
Presenter: Wendy Chen
Affidavit:
This work has neither been presented nor published. Wendy Chen was instrumental in the conception and undertaking of this study as well as the abstract preparation
Director Name: Vu Nguyen
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Purpose: Long term dental morbidities and aberrant mandibular morphology secondary to mandibular distraction osteogenesis are under-reported and may represent significant dental restorative cost, increased time in treatment, and complications to secondary definitive orthognathic surgery.
Methods: Retrospective review at a tertiary craniofacial center. Inclusion criteria: patients with radiographic evaluation in the early mixed and early permanent dentition. Data included demographics, medical history, and dental survey.
Results: Twenty-two patients: 12 syndromic (54.5%), 9 with hemifacial microsomia (40.9%). Average age at first MDO: 7.95 years; 9 required >1 distraction, 10 required tracheostomy. Average age at last follow-up: 15.1 years.
Early mixed dentition: All patients had dental anomalies. Molars anomalies: missing (8, not including 3rd molars), impaction (1), ectopia (4), dysplastic morphology (5). Premolar anomalies: ectopia (1); missing (2), impacted (2). Also noted: one impacted canine, one impacted lateral incisor. Two had aberrant V-shaped sigmoid notching.
Early permanent dentition: 24 distracted hemi-mandibles (6 hemifacial microsomia), 3 with no anomalies, four with an aberrant V-shaped sigmoid notch. Molars: missing (17), impacted (2), ectopia (4) 2 dysplastic (2), ankylosis (3). Premolars: 7 missing, impaction (2). Canine: 1 missing, 3 impacted. Incisors: 1 impacted (lateral), 1 missing (central).
Additionally, two patients had aberrant buccal mucosal scarring.
Conclusion: Mandibular distraction osteogenesis can lead to iatrogenic damage to the dentition and associated anatomy. Adequate informed consent, and consideration of the associated dental anatomy must be accounted for in osteotomy site selection and distractor placement.
