Simultaneous orbital expansion and intraoral distraction osteogenesis of upper and lower jaws in a patient with hemifacial microsomia.

BACKGROUND Correction of a micro-orbit, caused by clinical anophthalmia is a very challenging task. In hemifacial microsomia a micro-orbit may be combined with hypoplasia of the malar and the ascending mandibular ramus. MATERIAL A 5-year-old patient with hemifacial microsomia is described. Hypoplasia of the malar bone and the tilted occlusal plane were corrected by means of intraoral distraction osteogenesis in the upper jaw following precise simulation surgery on a 3D-model. At the same time, the ascending mandibular ramus was lengthened with a second distraction device and a spherical tissue expander was inserted into the hypoplastic orbit. RESULTS The malar as well as upper and lower jaws were lengthened and positioned symmetrically. The orbital cavity was expanded to 79% of that of the healthy side. Following removal of the distraction devices, the expander was exchanged for a larger one and orbital expansion was continued until overcorrection of the orbit up to 118 percent was achieved. CONCLUSION Orbital expansion is a minimally invasive method of enlarging the volume of the eye socket three-dimensionally. Intraorally activated buried distraction devices enable "growth" of the jaws making bone transplants avoidable in many cases. By combining both methods, complex malformations can be corrected simultaneously in children.