Model test study on treatment of Pruzansky type <b>Ⅱ</b>B and <b>Ⅲ</b> hemifacial microsomia with artificial condyle-mandibular distractor complex_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHAO Ruilin , FU Xi , QIAO Jia , HE Yu , XU Shixing , CHEN Ying , YU Bing , LIU Jianfeng ,  NIU Feng

The First Department of Craniomaxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100144, P. R. China;

Corresponding author：

NIU Feng, Email: niufeng@psh.pumc.edu.cn

Keywords：

Hemifacial microsomia; mandibular distraction; model test

DOI：

10.7507/1002-1892.202306022

Video：

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Objective To preliminarily verify the effectiveness of self-designed artificial condyle-mandibular distraction (AC-MD) complex in the treatment of Pruzansky type ⅡB and Ⅲ hemifacial microsomia (HFM) through model test. Methods Five children with Pruzansky type ⅡB and Ⅲ HFM who were treated with mandibular distraction osteogenesis (MDO) between December 2016 and December 2021 were selected as the subjects. There were 3 boys and 2 girls wih an average age of 8.4 years (range, 6-10 years). Virtual surgery and model test of AC-MD complex were performed according to preoperative skull CT of children. The model was obtained by three-dimensional (3D) printing according to the children’s CT data at a ratio of 1∶1. The occlusal guide plate was designed and 3D printed according to the children’s toothpaste model. The results of the model test and the virtual surgery were matched in three dimensions to calculate the error of the residual condyle on the affected side, and the model test was matched with the actual skull CT after MDO to measure and compare the inclination rotation of the mandible, the distance between the condylar of the healthy side and the residual condyle of the affected side, and the lengthening length of the mandible. Results The error of residual condyle was (1.07±0.78) mm. The inclination rotation of the mandible, the distance between the condylar of the healthy side and the residual condyle of the affected side, and the lengthening length of the mandible after 3D printing model test were significantly larger than those after MDO (P<0.05). Conclusion In the model test, the implantation of AC-MD complex can immediately rotate the mandible to the horizontal position and improve facial symmetry, and the residual condyle segment can be guided close to the articular fossa or the preset pseudoarticular position of the skull base after operation.

Citation： ZHAO Ruilin, FU Xi, QIAO Jia, HE Yu, XU Shixing, CHEN Ying, YU Bing, LIU Jianfeng, NIU Feng. Model test study on treatment of Pruzansky type ⅡB and Ⅲ hemifacial microsomia with artificial condyle-mandibular distractor complex. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(10): 1270-1275. doi: 10.7507/1002-1892.202306022 Copy

1.	Birgfeld C, Heike C. Craniofacial microsomia. Clin Plast Surg, 2019, 46(2): 207-221.
2.	Gougoutas AJ, Singh DJ, Low DW, et al. Hemifacial microsomia: clinical features and pictographic representations of the OMENS classification system. Plast Reconstr Surg, 2007, 120(7): 112e-113e.
3.	Kaban LB, Mulliken JB, Murray JE. Three-dimensional approach to analysis and treatment of hemifacial microsomia. Cleft Palate J, 1981, 18(2): 90-99.
4.	Vento AR, LaBrie RA, Mulliken JB. The O. M. E. N. S. classification of hemifacial microsomia. Cleft Palate Craniofac J, 1991, 28(1): 68-76.
5.	Kaban LB, Moses MH, Mulliken JB. Surgical correction of hemifacial microsomia in the growing child. Plast Reconstr Surg, 1988, 82(1): 9-19.
6.	Paul MA, Opyrchał J, Knakiewicz M, et al. Hemifacial microsomia review: Recent advancements in understanding the disease. J Craniofac Surg, 2020, 31(8): 2123-2127.
7.	Brody-Camp S, Winters R. Craniofacial distraction osteogenesis. StatPearls [Internet]: StatPearls Publishing, 2023: 1-8. https://www.ncbi.nlm.nih.gov/books/NBK560915/.
8.	Weichman KE, Jacobs J, Patel P, et al. Early distraction for mild to moderate unilateral craniofacial microsomia: Long-term follow-up, outcomes, and rcommendations. Plast Reconstr Surg, 2017, 139(4): 941e-953e.
9.	Xu J, Liu W, Deng X, et al. Effects of mandibular distraction osteogenesis on anesthetic implications in children with hemifacial microsomia. Acta Anaesthesiol Scand, 2022, 66(7): 823-832.
10.	Tahiri Y, Chang CS, Tuin J, et al. Costochondral grafting in craniofacial microsomia. Plast Reconstr Surg, 2015, 135(2): 530-541.
11.	中华医学会整形外科学分会颅颌面外科专业学组 (筹备组), 中华医学会整形外科学分会外耳整形再造专业学组 (筹备组), 中华医学会整形外科学分会脂肪移植专业学组 (筹备组), 等. 中国半侧颜面短小畸形·下颌骨畸形临床诊疗指南. 中华整形外科杂志, 2018, 34(1): 1-5.
12.	Converse JM, Coccaro PJ, Becker M, et al. On hemifacial microsomia. The first and second branchial arch syndrome. Plast Reconstr Surg, 1973, 51(3): 268-279.
13.	Shakir S, Bartlett SP. Modern mandibular distraction applications in hemifacial microsomia. Clin Plast Surg, 2021, 48(3): 375-389.
14.	Perez DE, Wolford LM. Contemporary management of temporomandibular joint disorders. Oral Maxillofac Surg Clin North Am, 2015, 27(1): ix.
15.	Zavala A, Ore JF, Broggi A, et al. Pediatric mandibular reconstruction using the vascularized fibula free flap: Functional outcomes in 34 consecutive patients. Ann Plast Surg, 2021, 87(6): 662-668.
16.	Liu W, Xu X, Zhao S, et al. Mandibular distraction osteogenesis first for children with severe unilateral hemifacial microsomia: Treatment strategy and outcomes. J Craniofac Surg, 2022, 33(2): 485-490.
17.	Wan DC, Taub PJ, Allam KA, et al. Distraction osteogenesis of costocartilaginous rib grafts and treatment algorithm for severely hypoplastic mandibles. Plast Reconstr Surg, 2011, 127(5): 2005-2013.
18.	Guyuron B, Lasa Jr CI. Unpredictable growth pattern of costochondral graft. Plast Reconstr Surg, 1992, 90(5): 880-889.
19.	Lindqvist C, Pihakari A, Tasanen A, et al. Autogenous costochondral grafts in temporo-mandibular joint arthroplasty. A survey of 66 arthroplasties in 60 patients. J Maxillofac Surg, 1986, 14(3): 143-149.
20.	Lindqvist C, Jokinen J, Paukku P, et al. Adaptation of autogenous costochondral grafts used for temporomandibular joint reconstruction: a long-term clinical and radiologic follow-up. J Oral Maxillofac Surg, 1988, 46(6): 465-470.
21.	Saeed N, Hensher R, McLeod N, et al. Reconstruction of the temporomandibular joint autogenous compared with alloplastic. Br J Oral Maxillofac Surg, 2002, 40(4): 296-299.
22.	McCarthy JG. The role of distraction osteogenesis in the reconstruction of the mandible in unilateral craniofacial microsomia. Clin Plast Surg, 1994, 21(4): 625-631.
23.	Bartlett SP. No evidence for long-term effectiveness of early osteodistraction in hemifacial microsomia. Plast Reconstr Surg, 2010, 125(5): 1567-1568.
24.	Belcher RH, Phillips JD. Total facial nerve injury during mandibular distraction osteogenesis. Int J Pediatr Otorhinolaryngol, 2020, 136: 110182.
25.	Meazzini MC, Mazzoleni F, Gabriele C, et al. Mandibular distraction osteogenesis in hemifacial microsomia: long-term follow-up. J Craniomaxillofac Surg, 2005, 33(6): 370-376.
26.	Shakir S, Naran S, Lowe KM, et al. Balancing distraction forces in the mandible: Newton’s third law of distraction. Plast Reconstr Surg Glob Open, 2018, 6(9): e1856.
27.	郑吉驷, 张善勇, 杨驰, 等. 国产3D打印个性化全颞下颌关节的临床初步应用. 上海交通大学学报 (医学版), 2016, 36(9): 1287-1291.
28.	Sidebottom AJ. Alloplastic or autogenous reconstruction of the TMJ. J Oral Biol Craniofac Res, 2013, 3(3): 135-139.
29.	张晓虎, 陈敏洁, 邱亚汀, 等. 标准型人工颞下颌关节置换术应用效果初步报告. 上海口腔医学, 2012, 21(3): 298-302.

1. Birgfeld C, Heike C. Craniofacial microsomia. Clin Plast Surg, 2019, 46(2): 207-221.
2. Gougoutas AJ, Singh DJ, Low DW, et al. Hemifacial microsomia: clinical features and pictographic representations of the OMENS classification system. Plast Reconstr Surg, 2007, 120(7): 112e-113e.
3. Kaban LB, Mulliken JB, Murray JE. Three-dimensional approach to analysis and treatment of hemifacial microsomia. Cleft Palate J, 1981, 18(2): 90-99.
4. Vento AR, LaBrie RA, Mulliken JB. The O. M. E. N. S. classification of hemifacial microsomia. Cleft Palate Craniofac J, 1991, 28(1): 68-76.
5. Kaban LB, Moses MH, Mulliken JB. Surgical correction of hemifacial microsomia in the growing child. Plast Reconstr Surg, 1988, 82(1): 9-19.
6. Paul MA, Opyrchał J, Knakiewicz M, et al. Hemifacial microsomia review: Recent advancements in understanding the disease. J Craniofac Surg, 2020, 31(8): 2123-2127.
7. Brody-Camp S, Winters R. Craniofacial distraction osteogenesis. StatPearls [Internet]: StatPearls Publishing, 2023: 1-8. https://www.ncbi.nlm.nih.gov/books/NBK560915/.
8. Weichman KE, Jacobs J, Patel P, et al. Early distraction for mild to moderate unilateral craniofacial microsomia: Long-term follow-up, outcomes, and rcommendations. Plast Reconstr Surg, 2017, 139(4): 941e-953e.
9. Xu J, Liu W, Deng X, et al. Effects of mandibular distraction osteogenesis on anesthetic implications in children with hemifacial microsomia. Acta Anaesthesiol Scand, 2022, 66(7): 823-832.
10. Tahiri Y, Chang CS, Tuin J, et al. Costochondral grafting in craniofacial microsomia. Plast Reconstr Surg, 2015, 135(2): 530-541.
11. 中华医学会整形外科学分会颅颌面外科专业学组 (筹备组), 中华医学会整形外科学分会外耳整形再造专业学组 (筹备组), 中华医学会整形外科学分会脂肪移植专业学组 (筹备组), 等. 中国半侧颜面短小畸形·下颌骨畸形临床诊疗指南. 中华整形外科杂志, 2018, 34(1): 1-5.
12. Converse JM, Coccaro PJ, Becker M, et al. On hemifacial microsomia. The first and second branchial arch syndrome. Plast Reconstr Surg, 1973, 51(3): 268-279.
13. Shakir S, Bartlett SP. Modern mandibular distraction applications in hemifacial microsomia. Clin Plast Surg, 2021, 48(3): 375-389.
14. Perez DE, Wolford LM. Contemporary management of temporomandibular joint disorders. Oral Maxillofac Surg Clin North Am, 2015, 27(1): ix.
15. Zavala A, Ore JF, Broggi A, et al. Pediatric mandibular reconstruction using the vascularized fibula free flap: Functional outcomes in 34 consecutive patients. Ann Plast Surg, 2021, 87(6): 662-668.
16. Liu W, Xu X, Zhao S, et al. Mandibular distraction osteogenesis first for children with severe unilateral hemifacial microsomia: Treatment strategy and outcomes. J Craniofac Surg, 2022, 33(2): 485-490.
17. Wan DC, Taub PJ, Allam KA, et al. Distraction osteogenesis of costocartilaginous rib grafts and treatment algorithm for severely hypoplastic mandibles. Plast Reconstr Surg, 2011, 127(5): 2005-2013.
18. Guyuron B, Lasa Jr CI. Unpredictable growth pattern of costochondral graft. Plast Reconstr Surg, 1992, 90(5): 880-889.
19. Lindqvist C, Pihakari A, Tasanen A, et al. Autogenous costochondral grafts in temporo-mandibular joint arthroplasty. A survey of 66 arthroplasties in 60 patients. J Maxillofac Surg, 1986, 14(3): 143-149.
20. Lindqvist C, Jokinen J, Paukku P, et al. Adaptation of autogenous costochondral grafts used for temporomandibular joint reconstruction: a long-term clinical and radiologic follow-up. J Oral Maxillofac Surg, 1988, 46(6): 465-470.
21. Saeed N, Hensher R, McLeod N, et al. Reconstruction of the temporomandibular joint autogenous compared with alloplastic. Br J Oral Maxillofac Surg, 2002, 40(4): 296-299.
22. McCarthy JG. The role of distraction osteogenesis in the reconstruction of the mandible in unilateral craniofacial microsomia. Clin Plast Surg, 1994, 21(4): 625-631.
23. Bartlett SP. No evidence for long-term effectiveness of early osteodistraction in hemifacial microsomia. Plast Reconstr Surg, 2010, 125(5): 1567-1568.
24. Belcher RH, Phillips JD. Total facial nerve injury during mandibular distraction osteogenesis. Int J Pediatr Otorhinolaryngol, 2020, 136: 110182.
25. Meazzini MC, Mazzoleni F, Gabriele C, et al. Mandibular distraction osteogenesis in hemifacial microsomia: long-term follow-up. J Craniomaxillofac Surg, 2005, 33(6): 370-376.
26. Shakir S, Naran S, Lowe KM, et al. Balancing distraction forces in the mandible: Newton’s third law of distraction. Plast Reconstr Surg Glob Open, 2018, 6(9): e1856.
27. 郑吉驷, 张善勇, 杨驰, 等. 国产3D打印个性化全颞下颌关节的临床初步应用. 上海交通大学学报 (医学版), 2016, 36(9): 1287-1291.
28. Sidebottom AJ. Alloplastic or autogenous reconstruction of the TMJ. J Oral Biol Craniofac Res, 2013, 3(3): 135-139.
29. 张晓虎, 陈敏洁, 邱亚汀, 等. 标准型人工颞下颌关节置换术应用效果初步报告. 上海口腔医学, 2012, 21(3): 298-302.

Chinese Journal of Reparative and Reconstructive Surgery

Model test study on treatment of Pruzansky type ⅡB and Ⅲ hemifacial microsomia with artificial condyle-mandibular distractor complex

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