Once the consolidation period was completed, reprogramming was undertaken to withdraw the distractor from the chin region to thus later place bilateral distractors in the lower jaw body Phase 2. Under general anesthesia and naso-tracheal intubation, an incision was made in the chin region over the previous incision scar. Dissection by planes was undertaken until bone region was approached. Distractor plates were identified, newly-formed bone tissue was clinically assessed. Distractor was then withdrawn, in the chin region an incision was performed around the distraction device rod. Suturing by planes was undertaken with 3-0 chromic catgut in deeper planes, and 4-0 nylon in skin planes. After this, an incision in the right, lower jaw basal ridge region was performed. Dissection by planes was undertaken until the bone was reached. All pre-existing previous fibula micro-vascular reconstruction materials were removed. The distractor was put into place, having previously been contoured according to the stereolythographic model. The distractor was fixated into place, osteotomies and osteotomes were marked with oscillating saw. Bone distraction functionality was assessed and recorded with oscillating saw, plane by plane closure was undertaken with chromic catgut 3-0 in deeper planes and 4-0 nylon in superficial planes. The same procedure was performed in a counter-lateral manner. Observing, as in the first phase a 5 days latency period, a 1 mm every 24 hours distractor activation was undertaken. The procedure was continued until reaching the desired 16mm length in the right side and 10mm length in the left side Figure 3. Once the distraction period was completed, a 6 month consolidation time was observed, to later remove distractors under general anesthesia.
Una vez terminado el periodo de consolidación, se procedió a reprogramar el paciente para el retiro del distractor de región mentoniana y colocación de distractores bilaterales de cuerpo mandibular Segunda fase, de igual manera bajo anestesia general balanceada y bajo intubación nasotraqueal, se realizó una incisión en la región mentoniana sobre la cicatriz de incisión previa, se disecó por planos hasta lograr abordar la región ósea, se identificó placas de distractor, se verifica clínicamente el tejido óseo neoformado, se retiró el distractor, se realizó incisión alrededor del vástago del aditamento de distracción en región mentoniana, se sutura por planos con cat-gut crómico 3-0, planos profundos y plano cutáneo con nylon 4-0, en seguida se realizó una incisión en la región de borde basal mandibular derecho, se disecó por planos hasta encontrar tejido óseo, se retiró material de osteosíntesis preexistente de la etapa de reconstrucción de injerto microvascularizado de peroné, se colocó distractor previamente contorneado de acuerdo al modelo de estereolitografía, se fijó el distractor y se marcan osteotomías con sierra oscilante, se retira el distractor, se completan osteotomías con sierra oscilante y osteotomos, se verifica la funcionalidad del distractor óseo, y se procedió al cierre por planos con cat-gut crómico 3-0 plano profundos y nylon 4-0 planos superficiales, realizándose mismo procedimiento de manera contralateral, al igual que en la primera fase posterior a un periodo de latencia de 5 días se procedió a la activación de los distractores 1 mm cada 24 h. Hasta la longitud planeada de 16 mm del lado derecho y 10 mm del lado izquierdo Figura 3, posteriormente completado el periodo de distracción, se esperó un periodo de consolidación de 6 meses para el posterior retiro de los distractores bajo anestesia general.