Reconstruction of a large mandibular defect by distraction osteogenesis: a case report.

Experimental studies have shown that large corrections of mandibular defects can be done by distraction osteogenesis. Annino et al1 investigated the feasibility of trifocal distraction for the reconstruction of symphyseal defects and they obtained 4.5to 5.5-cm lengthening in canine mandibles by using a rate of 1 mm/day.1 Labbe et al2 used distraction osteogenesis in 5 patients who had gunshot wound defects and produced bilateral lengthening of 5 to 10 cm by using an intraoral device. They also noticed that the distraction created an alveolar ridge and attached gingiva. Sawaki et al3 used distraction osteogenesis for reconstruction of a 60-mm mandibular segmental defect that resulted from excision of an oral floor cancer. They performed trifocal distraction by using an external device. The gap was almost filled by regenerated bone, and a small free bone graft was placed to complete the continuity. Generally, large corrections are done by trifocal distraction, and the process usually ends with bone-to-bone contact. The major distinction in this case is that bifocal distraction was used for the correction of a large unilateral mandibular defect. A free proximal bone segment was completely separated from the remaining mandible and was brought in contact with the temporal bone.