Med. J. Cairo Univ., Vol. 81, No. 1, March: 227-234, 2013 www.medicaljournalofcairouniversity.com Bilateral Distraction Osteogenesis for the Management of Mandibular Hypoplasia MOHAMMED S. HAMED, Ph.D.*; AMRE A. EL SWIFY, Ph.D.*; FAWZY T. ELSAYED, Ph.D.** and TAIB A. MOHAMMED, Ph.D.** The Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Suez Canal Univerisity* and The General Organization of Teaching Hospitals and Institutes** Abstract Introduction: Patients with mandibular bilateral hypoplasia usually present with varying degrees of facial deformity, upper airway obstruction and difficulty with feeding. Treatment of such cases is very important. Distraction osteogenesis (DO) using intra and extra-oral devices provides an excellent alternative when other surgical techniques do not prove to be satisfactory. Aim of the Work: To evaluate the efficacy of bilateral DO in the treatment of mandibular hypoplasia. Patients and Methods: Ten patients (7 females and 3 males), their ages ranged from 7 years to 23 years (with a mean of 14.45 years). They presented with bilateral mandibular hypoplasia with facial deformity, difficulty in feeding and three of them presented with obstructive sleep apnoea. All patients were treated with bilateral mandibular distraction osteogenesis, using intra and extra-oral unidirectional distrac- tors. The follow-up periods were immediately, 3 months, 6 months and one year post distraction. Results: The patients were successfully treated using bilateral unidirectional distractors After completion of distrac- tion, retrognathia was corrected in all patients. The "subjective" symptoms had disappeared completely or had been alleviated with obvious increase of airway space. And good stability of skeletal changes (defined by the lateral cephalograms measurements). Conclusion: DO is an effective method for management of facial deformity and obstructive sleep apnea with good stability of the results. Key Words: Distraction osteogesis — Obstructive sleep apnoea i — Mandibular lengthening — Surgical correction of mandibular hypoplasia. Introduction MANDIBULAR hypoplasia is one of the most common problem that falls into the dentofacial deformity category, patients with the true mandib- Correspondence to: Dr. Mohammed S. Hamed, The Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Suez Canal Univerisity ular deficiency represent about 40% of the total pool of potential dentofacial patients Mandibular hypoplasia usually leads to facial asymmetry, reduction of oropharyngeal capacity, upper airway obstruction, snoring, in addition to feeding diffi- culties and gastroesphogeal reflux, mandiublar hypoplasia can be congential, developmental, or acquired [1-3]. Techniques such as functional orthopedics and orthodontics alone are inadequate modalities for management of the mandibular deficiency [4]. Different orthognathic surgeries can be used for treatment of mandibular deficiency such as inverted "L" osteotomy, vertical ramus osteotomy and bilateral sagittal split osteotomy, although orthognathic surgeries were gaining wide spread acceptance but they have several problems includ- ing intraoperative nerve damage, marked postop- erative displacement of bone segments due to inadequate bony contact and insufficient fixation stability and partial or total relapse as a result of acute muscle stretching [5,6]. Nowadays mandibular skeletal deficiency can be corrected successfully by the mandibular dis- traction osteogenesis which has the potential to overcome the hazards associated with bilateral sagittal split osteotomy. Distraction osteogensis provide higher stability with more preservation of inferior alveolar nerve than bilateral sagittal split osteotomy specially in cases required larger man- dibular advancement [7,8]. In this article, we report our experience in correction of bilateral mandibular hypoplasia and management of obstructive sleep apnea with re- porting stability of the results. 227