Pacific Coast Society of Orthodontists Bulletin Summer 2023 - 63

Let's Talk About That
Internal devices are, however, more common than
external devices. In the mandible, most distraction
is done internally. The reason is that external
devices in the mandible can leave unsightly scars,
whereas internal devices leave either no external
scars or better hidden scars. In the midface, internal
devices also leave little scars, but external devices
can also leave minimal scars. The stigma against external
midface devices is that there is a metal halo
that is screwed into the patient's skull, which they
must wear for 3 to 4 months. The device is unsightly,
and it is difficult for patients to sleep wearing
these devices.
PKT: Can distraction osteogenesis be performed in
both jaws simultaneously?
WO: Unlike orthognathic surgery, in distraction
osteogenesis, it is more difficult to achieve a precise
Class I occlusion. To help with distraction, I will
often use guiding elastics to help finalize the patient's
occlusion. Although it is possible to perform
distraction osteogenesis in both jaws simultaneously,
it is easier to perform distraction in one jaw while
using the other jaw to guide the occlusion. Then
distraction osteogenesis can be performed in the
other jaw if needed.
PKT: Can distraction osteogenesis be performed in
more than one direction?
WO: Yes, using an internal multidirectional mandibular
distractor, you can distract the mandible
in more than one direction (Figure 9). For midface
distraction, the internal distractors can only be
done in one plane. One of the benefits of the
external midface and mandibular distractors is that
the direction of distraction can be modified in the
middle of distraction.
PKT: Can distraction osteogenesis be performed
early and then again as the individual matures?
WO: Yes, distraction osteogenesis can be performed
more than once. For example, a patient
with Pierre Robin sequence can have distraction
Figure 9. KLS-Martin internal multidirectional
mandibular distractor
Figure 10. Hemifacial microsomia mandibular
distraction
osteogenesis performed as an infant. Then in many
instances, distraction will be required again as
adults because of continued delayed mandibular
growth. The same is true with patients with severe
hemifacial microsomia (Figure 10).
PKT: Is distraction osteogenesis a fad or is it here to
stay?
WO: Although distraction osteogenesis will not be
performed to the same level as orthognathic surgery,
it is a workhorse that is here to stay. It is vitally
important in craniofacial cases where the movements
are large or the soft tissue envelop is tight
or scarred. Distraction can be used in cases where
orthognathic surgery has a high rate of relapse, like
patients with cleft lip and palate.
Summer 2023 PCSO Bulletin
63

Pacific Coast Society of Orthodontists Bulletin Summer 2023

Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Summer 2023

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Pacific Coast Society of Orthodontists Bulletin Summer 2023 - Cover3
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