Laboratory Studies

Depending on the patient's age, at a minimum, complete blood count, platelet count, and coagulation studies should be performed.

Imaging Studies

A panoramic radiograph should be obtained. This imaging provides the surgeon with better visualization of mandible morphology. A preoperative planned osteotomy is drawn in the diagnosis tracing; it should include maxilla and mandible. The PA cephalometric radiograph is another diagnostic tool, used to determine the amount of vertical and transverse (horizontal) mandibular distraction. It is the best film for determining vertical distraction due to better visualization of both mandibular angles. A diagnostic tracing of the PA cephalometric radiograph is made, as well as a drawing of the osteotomy to correspond with the diagnostic tracing of the Panorex.

Complicated cases may require CT scans with 3-dimensional reconstruction and stereolithographic models to help in planning the location of the osteotomy and the vector of distraction.

Mounted dental models on a semiadjustable articulator are often helpful in determining the vector of distraction, and optimizing the dental occlusion.

Treatment & Management

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Media Gallery

Distraction osteogenesis of the mandible. Alveolar distractor used to increase the height of the alveolar bone. Courtesy of K.L.S. Martin, LP.
Distraction osteogenesis of the mandible. A reciprocating saw is used to osteotomize inferior, lateral, and superior portions of the mandible. An osteotome is then used to complete the bony cut. Courtesy of Jordan Mastrodonato, MS, Medical Illustrator, Eisenhower Army Medical Center.
Distraction osteogenesis of the mandible. Intraoral distraction device in place. Courtesy of K.L.S. Martin, LP.
Temporomandibular joint ankylosis following distraction osteogenesis
Mandibular distractor used for maxillomandibular advancement for the treatment of OSA. Courtesy of K.L.S. Martin, LP.

of 5

Author

Dale A Baur, MD, DDS Vice Dean, Professor, and Chair, Department of Oral and Maxillofacial Surgery, Case Western Reserve University School of Dental Medicine; Division Chief, Oral and Maxillofacial Surgery, University Hospitals/Cleveland Medical Center

Dale A Baur, MD, DDS is a member of the following medical societies: American Association of Oral and Maxillofacial Surgeons, American College of Oral and Maxillofacial Surgeons, American Dental Association

Disclosure: Nothing to disclose.

Coauthor(s)

Joseph Helman, DMD C J Lyons Endowed Professor, Department of Oral and Maxillofacial Surgery, University of Michigan Medical School

Joseph Helman, DMD is a member of the following medical societies: American Association of Oral and Maxillofacial Surgeons, American Cleft Palate-Craniofacial Association, American Head and Neck Society, International Academy of Oral Oncology, American College of Oral and Maxillofacial Surgeons

Disclosure: Nothing to disclose.

Mehmet Ali Altay, DDS, PhD Research Fellow, Department of Oral and Maxillofacial Surgery, Case Western Reserve University School of Dental Medicine; Doctor of Oral and Maxillofacial Surgery, Akdeniz University Faculty of Dentistry, Turkey

Mehmet Ali Altay, DDS, PhD is a member of the following medical societies: International Association of Oral and Maxillofacial Surgeons, Turkish Association of Oral and Maxillofacial Surgeons

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Checkpoint Surgical LLC.

Juan Carlos Rodriguez, DDS Research Associate, Department of Oral and Maxillofacial Surgery, Case Western Reserve University School of Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Robert M Kellman, MD Professor and Chair, Department of Otolaryngology and Communication Sciences, State University of New York Upstate Medical University

Robert M Kellman, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Head and Neck Society, American Rhinologic Society, Triological Society, American Neurotology Society, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, Medical Society of the State of New York

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan, Ryte, Neosoma, MI10<br/>Received income in an amount equal to or greater than $250 from: , Cliexa;;Neosoma<br/> Received ownership interest from Cerescan for consulting; for: Neosoma, eMedevents, MI10.

Additional Contributors

Mimi S Kokoska, MD Physician, Department of Otolaryngology-Head and Neck Surgery, Aurora Health Care

Mimi S Kokoska, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Association for Physician Leadership, American College of Surgeons, American Head and Neck Society

Disclosure: Nothing to disclose.