Jun-ichi Fukuda

Correction of Mandibular Asymmetry Due to Hemifacial Microsomia Using a Custom-made Implant

Abstract Custom-trade artificial bone produced by the figurative lithographic method based on 3-dimensional computed tomography data is now available as a compatible and reliable implant. We describe a patient with hemifacial microsomia who was treated with custom-made artificial bone, trade from hydroxyapatite, for facial symmetry. Using the implant was less invasive surgically and shortened the operating time. A full-scale model and template were created using the binder jet method and 3-dimensional computed tomography images reformatted with single-helical scan data. These technologies were useful for producing the custom-made implant and explaining the procedure to the patient perioperatively. A symmetrical profile of the patients face has been maintained without any resorption of the implant and graft bed for 3 years. The hydroxyapatite custom-made implant was effective for facial rehabilitation in the treatment of mandibular asymmetry due to hemifacial microsomia.

Progressive Hemifacial Atrophy Treated by Orthodontic Surgery

Abstract Progressive hemifacial atrophy (PHA) is a self-limited atrophy of subcutaneous tissues (and less frequently of hard tissues) on one side of the face. It is a sporadic, slowly progressing disease whose pathogenesis is still unknown. As a rule the asymmetry caused by PHA (usually of soft tissue) is treated by volume augmentation that involves free tissue grafting or a pedicled flap transfer. We describe a rare case of hard tissue PHA. The atrophic changes occurred in the left molar tooth, maxilla and mandible and were associated with moderate soft tissue atrophy. The left side of the patients mouth was higher on the right side, and the occlusal plane was severely inclined in spite of normal occlusion. After no alteration and no progression of the atrophy were established, the patient was treated with orthodontic surgery. To correct the inclined occlusal plane and asymmetry profile, we performed a Le Fort I and intraoral vertical ramus osteotomy. In the 3-year follow-up, there were good occlusal balance and improved symmetrical profile without relapse or recurrence of the atrophy. Thus, orthodontic surgery was effective as a first procedure to treat hard tissue atrophy that appeared with moderate soft tissue atrophy.