Mandibular distraction osteogenesis effects
Permanent molar malformation and destruction as a result of mandibular distraction osteogenesis surgery 🦷🛠
CC: “missing and weird shape teeth in the back”
Dx: missing #18 and #19, malformed/carious #30, malformed #31
Tx: referral to OMFS and plastics, recommended monitoring #30 caries (controlling sensitivity with SDF) and #31 for eruption
🔑: Micrognathia (small lower jaw) is associated with certain syndromes such as hemifacial/craniofacial microsomia, Goldenhar syndrome, and Treacher Collins syndrome. In severe cases, it can restrict the patient’s ability to eat and interfere with airway function. Mandibular distraction osteogenesis (MDO) is one surgical option to remedy this. To summarize, MDO involves cutting the mandible bilaterally and placing a device that allows for the two segments of the mandible to be gradually separated. Separation of the mandibular segments stimulates new bone growth so with gradual separation, increased mandibular bone length is achieved. Children’s Minnesota has a great overview of this; just google “Children's Minnesota Mandibular Distraction Surgery”.
MDO is not without its complications. Because this procedure takes place at the site of the developing tooth buds of the mandibular molars, it is only logical that they can be adversely affected. In our panoramic radiograph, you can see #18 and #19 are completely missing and #30 and #31 are malformed. After consultation with OMFS and plastics, it is recommended that we monitor due to the difficult nature of this case (thin mandible and limited opening). Future treatment needs may include extraction and implant placement.
Let’s look into the literature. In one study, 17 patients with a history of MDO were evaluated. Of the 17 patients and 63 mandibular molars, 13 patients and 18 mandibular molars were affected with changes ranging from “root malformations, hindered tooth development and the destruction of tooth follicles.”
Kleine‐Hakala, Marja, Jyri Hukki, and Kirsti Hurmerinta. "Effect of mandibular distraction osteogenesis on developing molars." Orthodontics & craniofacial research 10.4 (2007): 196-202.
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