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Simultaneous Maxillo Mandibular Distractor Removal with Lateral Defect Augmentation With Rib Grafts

The patient is a young woman with distortion of her lower face due to mandibular asymmetry. This had lead to her socially isolating herself due to people staring at her and passing comments since she was a little girl. She presented to Balaji Dental and Craniofacial Hospital, Teynampet, Chennai, for correction of her condition. Dr. S. M. Balaji, Maxillo-Craniofacial Surgeon, viewed her 3-D axial CT scans and decided to perform simultaneous maxillomandibular distraction for the patient to correct her vertical mandibular deficiency and occlusal cant on the right side. Maxillomandibular distraction was successfully performed and her facial asymmetry was set right, but there was a persistent bone deficiency in the right side of her mandible. She now presents for removal of her distractors as well as for placement of rib grafts for correction of her bone defect.

The patient was taken to the operating theatre where general anesthesia was induced. Two rib grafts were taken from the right side for filling in the bony deficiency on the right side of her mandible and the incision was closed in layers with sutures. A right-sided submandibular incision was made and dissection was carried down to the level of the distractor. The distractor was then unscrewed and removed uneventfully. The rib grafts were then shaped and screwed in place to fill in the bone deficiency in the mandible.

The patient presented to Dr. Balaji a few months after the surgery and expressed her delight at the way he had given her a new lease of life by setting right her facial asymmetry.