Molina Osteo Distraction Systems


	Developed in cooperation with Fernando Molina M. D. Mexico City, Mexico
	Intraoperative Approach Distraction Technique The Molina Baby Mandibular Distractor The Molina Mandibular Distractors The Molina Mandibular Distractors Bi-directional

	Intraoperative Approach
	The procedure is done under general anaesthesia. A 3 - 5 cm incision is made in the oral mucosa along the lateral mandibular vestibule. Using the panorex view of the mandible, to locate the position of the toothbuds, the site for the insertion of the pins is determined. The exact position of the corticotomy is determined. The corticotomy and the position of the pins will deter-mine the vector of the distraction according to the degree of mandibular hypoplasia. The periosteum is elevated to expose the gonial angle and the neighboring area of the ascending ramus and the mandibular body. A corticotomy is made on the lateral mandible and the cancellous bone is exposed. The corticotomy is extended inferiorly around the lower border of the mandible where the bone is thick and then extended to the retromolar triangle. The mandibular vessels and nerves are not exposed, the lingual cortical plate and the cancellous layer remains intact. The pins are inserted percutanously manually or using a handdrill with irrigation to avoid thermal injury to the bone. The pins are placed parallel to each other to facilitate their fixation to the distractor. The mucosa is closed and the distraction device is applied to the pins. The distraction is started on the fifth post-operative day at a rate of 1 mm per day. The distraction is completed according to the treatment planning (in general 3 - 4 weeks). The device is left in place for 6 - 8 additional weeks to complete the consolidation period. In patients with micrognathia two corticotomies are performed, one vertical in the mandibular body and the other one horizontal in the ascending ramus. Three pins are used to allow the bi-directional devices to achieve independent and precise elongation of each segment.


	Distraction Technique
	Mandibular deformity observed in hemifacial microsomia of varying severity. The dotted lines indicate the amount of missing bone.
	Location of the corticotomy and vector of the distraction forces in Class I hemifacial microsomia, Class IIA hemifacial microsomia and in Class IIB hemifacial microsomia.
	An incision is made on the mandibular buccal vestibule. Extent of the periosteal undermining on the lateral aspect of the mandible. The direction of the corticomy extending obliquely from the free edge of the mandibular angle. The corticotomy extends around the free posterior edge where the bone is thicker. Notice the site for introduction of the intraosseous pins.
	The pins must penetrate the whole thickness of the bone. The external cortical layer is eliminated at the corticotomy site. The cancellous and internal cortical layers remain intact. The cheek skin is pinched between the fingers before the introduction of the pins to minimize the scarring produced by the distraction pins. The parallel position of the intraosseous pins and the corticotomy immediately after surgery. The short vertical dimension of the maxilla is shown in the vertical line.
	After elongation, the intraosseous pins that were originally parallel become divergent, and the corticotomized section of the mandible is enlarged. When the distraction is completed, a zone of low bone density in the external cortex is observed. It is narrow at the free border and wide at the posterior margin because the elongation follows the curve of mandibular growth. When vertical and horizontal distraction is necessary, two corticotomies are performed, one in front and another above the angle. Three pins are used. The central one at the angle serves as a pivot for the two independent vertical and horizontal distraction devices.

	The Molina Baby Mandibular Distractor

51-600-28	Distraction length 28 mm

51-606-40	Pins 2 x 40 mm, 2 each

51-606-12	Pins 2 x 120 mm, 1 each

51-600-85	Screwdriver for pins

51-600-90	Activator and Fixation Screwdriver


	The Molina Mandibular Distractors

51-600-43	Distraction length 43 mm, for children

51-608-60	Pins 2.7 x 60 mm, 2 each

51-600-53	Distraction length 53 mm, for adults

51-610-60	Pins 3.2 x 60 mm, 2 each

51-600-85	Screwdriver for pins

51-600-90	Activator and Fixation Screwdriver


	The Molina Mandibular Distractors Bi-directional

51-601-56 51-602-56	Distraction length 56 x 40 mm, left, for children Distraction length 56 x 40 mm, right, for children

51-608-60	Pins 2.7 x 60 mm, 2 each

51-601-76 51-602-76	Distraction length 76 x 40 mm, left, for adults Distraction length 76 x 40 mm, right, for adults

51-610-60	Pins 3.2 x 60 mm, 2 each

51-600-85	Screwdriver for pins

51-600-90	Activator and Fixation Screwdriver