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Revista odontológica mexicana
Print version ISSN 1870-199X
Rev. Odont. Mex vol.10 n.4 Ciudad de México Dec. 2006
https://doi.org/10.22201/fo.1870199xp.2006.10.4.15888
Trabajos originales
Tratamiento quirúrgico ortodóntico de microsomía hemifacial mediante elongación ósea intraoral de rama mandibular
Orthodontic surgical treatment of hemifacial microsmia using intraoral mandibular ramus bone elongation technique
* CMF de Práctica Privada, egresada del ISSSTE, HRGIZ Profesor por Oposición del Instituto Politécnico Nacional.
§ CMF, Mtro. Profesor Titular de la Especialidad de Cirugía Maxilofacial en el Hospital Regional Gral. I. Zaragoza ISSSTE.
II MC, CMF. Profesor adscrito al Servicio de Cirugía Maxilofacial del Hospital Universitario “La Princesa”. Madrid, España.
Las deformidades dentofaciales, cada vez más frecuentes en la consulta del cirujano maxilofacial, se relacionan siempre con alteraciones de las estructuras óseas y dentales subyacentes en cualquiera de los tres planos del espacio: sagital, vertical y transversal, siendo en muchos casos en todos ellos. La hipoplasia mandibular es uno de los principales problemas con los que clásicamente se enfrenta el cirujano. La dificultad radica en que durante el crecimiento se produce una asimetría cada vez más marcada, con laterodesviación mentoniana, mordida cruzada y mordida abierta posterior, que es compensada por una desviación del plano oclusal, causando problemas estéticos y funcionales. La elongación ósea en las mandíbulas hipoplásicas es una técnica con la cual se logran notables cambios tanto en hueso como en tejidos blandos y vasculares adyacentes en poco tiempo y sin necesidad de grandes procedimientos quirúrgicos, permitiendo el tratamiento precoz de estas deformidades. Se presentan nueve casos con asimetría facial con diagnóstico de microsomia hemifacial, tratados mediante elongación ósea vertical de rama mandibular, se valoraron las características físicas, fotografías clínicas, radiografías convencionales posteroanterior y lateral de cráneo, ortopantomografía y tomografia computarizada con reconstrucción tridimensional.
En todos los casos se realizó elongación vertical de rama mandibular bajo anestesia general, obteniendo resultados estéticos y oclusales favorables con simetría facial y oclusión estable, con el mínimo de complicaciones de dolor temporomandibular y parestesia mentoniana temporal, mordida abierta posterior y mordida cruzada anterior, registrando un crecimiento maxilar compensatorio, requiriendo ortodòncia prequirúrgica y posquirúrgica. Todos los procedimientos se llevaron a cabo con éxito, vigilando la evolución de 6 meses a dos años, sin complicaciónes, ni recidivas.
Palabras clave: Microsomia hemifacial MHF; elongación ósea EO
Dentofacial deformities have increased in frequency in oral and maxillofacial surgeons practice. This group of deformities are related with bone and dental structures in any of three spacial planes: vertical, sagital and tranverse or a combination of all them. Mandibular hypoplasia is one of the most common problems dentists have to face. Complexity arises when the asym metry becomes more evident as patient grows, with laterognatia and chin deviation, cross bite and posterior open bite; these problems are counteracted by an occlusal plane deviation, re-suiting in functional and esthetic abnormalities. Bone elongation in hypoplasic mandibles is a technique that produces notable changes in bone as well as soft and vascular tissues in a brief period of time, without the need of complex surgical procedures; allowing treatment at its early stages. This paper presents 9 cases of facial asymmetry due to hemifacial microsomia treated by osteogenic elongation of mandibular ramus. Clinical features and pictures, simple cranial views (posteroanterior and lateral), pan oramic view and computerized tomography with three-dimensional scan were evaluated. All cases were treated by mandibular ramus osteogenic elongation under general anesthesia, with favorable esthetic and functional outcomes, resulting in stable occlusion and facial symmetry, with minimum complications such as temporomandibular pain, temporary chin paresthesia, posterior open bite and anterior cross bite. Compensatory maxillary growth was noted, being necessary pre and postsurgical orthodontic treatment. All cases were successful, having control follow ups from 6 months to 2 years. No recurrence or other complications were present.
Keywords: Hemifacial microsomia HFM; bone elongation BE
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