Mandibular remodeling: The fifth stage in distraction osteogenesis healing

The purpose of this clinical investigation is to evaluate the long-term soft tissue facial changes after intraoral distraction osteogenesis to advance the mandible and relate these changes to the distraction healing process. The initial excitement shared by surgeons and patients of important soft tissue increase after distraction histogenesis have evolved to a progressive shrinkage and to a major disappointment, in the long-term evaluation. In order to exclude important variables that could vary the final outcome, ten non-syndromic patients (6 females and 4 mates; ages 16 years or older) underwent bilateral intraoral distraction osteogenesis (8 to 12 mm movements) using the miniaturized universal Dynaform distractor and were followed for 36 months. Severe soft tissue edema is seen after surgery that ameliorates progressively towards the third month after surgery, once the distractors are removed a second phase of soft tissues shrinkage is observed up to the sixth month, finally a progressive decrease is seen until the 30(th) month post-surgically, with continuous bone and soft tissues changes. The mandibular range of motion was over 40 mm in every patient at the end of follow up. This study shows a different healing process to orthognathic surgery where at 6 months post intervention there are basically no soft tissues clinical changes, we did observed important remodeling variations after distraction osteogenesis up to 30 months after surgery.