Multiplanar and combined distraction osteogenesis for three-dimensional and functional reconstruction of unilateral large maxillary defects.

We have developed a new way of three-dimensional and functional reconstruction of unilateral large maxillary defects by multiplanar and combined distraction osteogenesis of the zygoma, maxillary alveolar process, and hard palate. In the first procedure we started the internal curvilinear distraction osteogenesis of the left zygoma in one patient who had had a left maxillectomy to rebuild midfacial bony support. In the second procedure, the internal curvilinear distraction osteogenesis of the maxillary anterior alveolar process and straight distraction osteogenesis of the right hard palate were used to restore the posterior alveolar process and left palate. In the third procedure, the distracted zygoma and alveolar process were connected by a small local bone graft. The important lost maxillary bony architecture was re-established three-dimensionally and resulted in a natural facial appearance, normal speech and swallowing, and good foundation for chewing. This may be the first example of three-dimensional and functional reconstruction of unilateral large maxillary defects that did not require bone grafts from other anatomical areas.