Patient 1 2 3 4 5 October 2009 - Vol.3 Age 14 17 18.3 27 16.3 Dolanmaz, Karaman, Gurel, Kalayci, Kucukkolbasi, Usumez an intraoral approach protecting inferior alveo- distractor was placed in the ascending ramus af- lar nerve. Due to difficulty experienced in placing ter performing an oblique osteotomy through an the distractors intraorally, the distractors were intra-oral approach. The fixation pins of the extra- placed after exposing the ramus through a 2.5 cm oral distractor were attached to the basal man- long extra-oral submandibular incision . Prior to dibular bone transcutaneously close to the pos- completion of the osteotomy, distractor (Vasquez- terior border of ramus above the osteotomy line. Diner type intra-oral distractor, Leibinger, Ger- Following a latency period of 1 week, activation many ) was adapted to the bone surface. An effort was started at a rate of 0.5 mm twice per day at was made to place the distractor perpendicular the vertical rod of the distractor (in patient 1), then to the osteotomy line. After a latency period of 1 continued at the horizontal rod until the sagittal week, active distraction was started at a rate of 0.5 mandibular deficiency was resolved. Once desired mm twice per day. mandibular lengthening was achieved, the fixa- In patients 2 and 3, intra-oral distractors (Me- tion screw was loosened and then moulding of the dartis, Modus MDO 2.0, Basel, Switzerland) were regenerate was carried out using anterior heavy used and an extra-oral distractor (Molina bi-di- elastics to obtain a stable occlusion. On the com- rectional extraoral mandibular distractor, KLS pletion of the moulding procedure, the consolida- Martin, USA) was used in patient 1. The intra-oral tion period started and lasted 12 weeks. distractor was placed as parallel as possible to rEsuLts the maxillary occlusal plane after performing a vertical osteotomy in the lower retromolar region In patient 4, the distraction rod fractured to- through an intra-oral approach and the extra-oral wards the end of the distraction procedure. The rod was then removed and the distractor was left in place for 3 months for the consolidation of the regenerate. Afterwards, the broken distractor was removed and replaced with another intra-oral dis- tractor (Guerrero-Bell type intra-oral distractor, Leibinger, Germany) following a vertical osteoto- my made in the mandibular corpus. In all patients, paresthesia developed on the related side(s) following surgery and intensified during distraction period. However, it disappeared gradually in the long term. Genioplasty was re- quired in some patients as mandibular asymmetry could no further be corrected by distraction osteo- genesis once a CL I canine relationship was estab- lished bilaterally. In patients 1,2 and 3, it was observed that the ANB angle decreased by a mean of 5°, the man- Figure 1. Landmarks and planes used in lateral cephalometric dibular corpus length increased by a mean of 14.5 analysis. Table 1. Clinical features of the patients. Sex Type of Distracion Genioplasty Follow-up period F M F M M Bilateral extra-oral Bilateral intra-oral Bilateral intra-oral Unilateral intra-oral Unilateral intra-oral Yes No Yes No Yes 337 European Journal of Dentistry 4.1 years 3.8 years 5.3 years 4 years 4.2 years