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PubMed2006

Le Fort III distraction osteogenesis in syndromal craniosynostosis.

Midface distraction osteogenesis has become a valuable technique. Although outcome data are available from several craniofacial centers, information regarding perioperative and immediate postoperative course is scarce. This report describes seven children, aged 4 to 17 years, with syndromal craniosynostosis in need of midface advancements. Most were rather complex cases with several previous craniofacial surgeries (mean 4.4 times, range 1-8). The Modular Internal Distraction System (Howmedica Leibinger, Inc., Rutherford, NJ) was used for the gradual Le Fort III advancements. The average midface advancement obtained was 23 mm (range 15-30 mm), resulting in improved facial profile, normalized or improved dental occlusion, reduced exophthalmos, and cessation or a significant decrease in preoperative respiratory problems. The mean length of operation was 354 minutes (range 300-535 minutes), and the mean amount of perioperative blood transfusion needed was 1251 mL (range 450-1800 mL) or 46.0 mL/kg (range 8.2-121.4 mL/kg). Complications included subcutaneous infections inferolaterally to the eye (N = 3) and forehead (N = 1). One patient had worsening of her facial profile and underwent a subsequent fronto-orbital advancement. One patient developed a deviation of the nasal septum and needed a corrective rhinoplasty. One patient developed marked trismus and one needed reoperation and trimming of the anchoring titanium plate on the malar process. In one patient, the lacrimal sac was lacerated, leading to transient epiphora. In most patients, Le Fort III distraction led to a significant improvement in the facial profile. However, surgery is still a major undertaking, with several potential complications. In our hands, the rate of complications is not less than for monobloc advancement. Thus, the choice of operation method is not based on which method is the least risky but on which is best suited for the individual patient.

Acrocephalosyndactylia↗
PubMed2000

[Application of distraction osteogenesis in functional mandibular reconstruction].

OBJECTIVE: To study the application of distraction osteogenesis in mandibular functional reconstruction. METHODS: Three kinds of mandibular distractors were used in 6 cases who had different mandibular defects because of tumor resection. For two cases with defect of most part of ramus specially desinged distractors were used in order to keep the normal height of the ramus. In one case the trifoci distraction principles were used and a trifoci distractor was desinged. In three cases the vertical distractors made in Germany or China respectively were used. The average age of 6 patients was 31.5 years old (from 8 to 54). RESULTS: The mandibular lengthenings in 5 cases were fully successful according to the direction and distance desinged before distraction. In one case the trifoci distraction principle was applied and a proximal 23 mm mandibular defect was corrected successfully, however, the 23 mm distal mandibular defect had not corrected because the screws for fixation of the transport block was loosened. No infection and dysosteogenesis were happened in all cases. CONCLUSIONS: Distraction osteogenesis can successfully be used in mandibular functional reconstruction and has much more advantages than traditional techniques. The most favorable time for distraction osteogenesis in mandibular reconstruction is at the same stage of tumor resection.

Adolescent↗
PubMed2000

Long-term skeletal and dental effects of mandibular symphyseal distraction osteogenesis.

The purpose of this study was to evaluate the effects of mandibular symphyseal distraction osteogenesis using a tooth-borne expansion device. The sample included 20 Hispanic nonsyndromic patients (11 males and 9 females) between 13.5 years and 37.3 years of age. Predistraction (1.5 months before surgery), postdistraction (1 month after surgery), and long-term follow-up (1.3 year after surgery) records included posteroanterior, lateral, and panoramic radiographs and models. Postdistraction radiographic evaluation showed that symphyseal distraction osteogenesis produced insignificant increases in the bicondylar, bigonion, and biantegonion widths; intermolar and, especially, intercanine widths increased significantly and a distraction gap was observed in the symphyseal region. Follow-up model analysis showed the largest width increases between the first molars and second premolars and the smallest width increases between canines and first premolars. The difference between the postdistraction and long-term follow-up width changes was explained by the postdistraction orthodontic effect, which modified the shape of the dental arch. A disproportionate pattern of distraction, characterized by significantly greater dental than skeletal widening, was observed in the second molar and antegonion region. Distraction osteogenesis without presurgical orthodontic treatment produced significant proclination of the mandibular incisors; no proclination was observed in cases with predistraction orthodontic treatment. Dental crowding was resolved by the movement of teeth into the distraction regenerate and concomitant orthodontic treatment. Follow-up radiographs showed transverse skeletal stability of the distraction procedure. We conclude that mandibular symphyseal distraction osteogenesis increased mandibular arch width and partially corrected dental crowding, with a potential for disproportionate distraction patterns and proclination of the mandibular incisors.

Adolescent↗
PubMed2001

Development of a device for the delivery of agents to bone during distraction osteogenesis.

Various agents have been theoretically and experimentally implicated as mediators of distraction osteogenesis (DO). The purpose of this study was to develop a vehicle for the potential delivery of these factors to the region of the distraction site in an attempt to manipulate this biologic process. Three adult mongrel dogs (12 months old) had oblique osteotomies performed bilaterally through the gonial regions. In group I, the external distracter was affixed to the right hemimandible of two dogs (n = 2 hemimandibles) with cannulated pins (external diameter = 1.5 mm; lumen diameter = 1.0 mm; length = 60 mm), whereas the distracter on the left was affixed with standard, noncannulated pins of the same dimensions. In group II, cannulated pins were used to affix the external distracter to both hemimandibles (n = 2 hemimandibles) of a dog. The devices were activated after a 5-day latency period and were lengthened at a rate of 1 mm/day for 20 days. During the distraction period, 0.1 ml/d of sterile india ink was injected into the cannulated pins, after which the sterile stylet was replaced. The activation protocol was followed by 28 days of fixation (consolidation period). The hemimandibles from group I underwent removal of soft tissues, acetone fixation, and gross examination/photography, whereas the hemimandibles from group II were prepared for histologic evaluation (whole mount, hematoxylin and eosin staining). All dogs survived to the end of the study and demonstrated successful DO without evidence of complications. Hemimandibles in group I displayed evidence of india ink on both the lingual and buccal cortex around the cannulated pin site, in the regenerate and on the neocortices of the distracted segment. Hemimandibles of group II showed histologic evidence of the india ink being deposited densely around the cannulated pin site and extending in a radial fashion around the pin site into the regenerate. This study demonstrates for the first time a vehicle device for the delivery of an inert dye to the regenerate site during distraction osteogenesis. This vehicle offers the potential of delivery of various factors implicated in distraction osteogenesis (i.e., mitogens) in an attempt to alter this process and also substances (i.e., chemotherapy, antibiotics, etc.) for use in the treatment of various osteopathies.

Animals↗
PubMed2005

[Mandibular distraction osteogenesis: an experimental study in goats].

OBJECTIVE: This experiment was designed to develop an experimental model of mandibular distraction osteogenesis in goats for determining the principle and the process of distraction osteogenesis. METHODS: Eight 3-month-old, healthy domestic goats were randomly divided into four groups (n = 2 per group). The animals from each group were killed at 1, 2, 4, and 6 weeks after bone distraction, respectively. The sections of newly formed bone were obtained and evaluated with histologic and radiographic study. We also assessed the newly formed bone with bone density examination. RESULTS: The specimens of right mandible increased averagely 10 mm after distraction. The Newly formed bone was demonstrated histologically. The X-ray examination and bone density measurements showed that the bone density increased with the time of fixation. CONCLUSION: Goat is a proper experimental animal for modeling mandibular distraction osteogenesis, and in this regal, it is important to keep the direction of distracter force in conformity with the direction of the expected distraction osteogenesis for avoiding the side force and thus ensuring successful distraction and good quality of newly formed bone.

Animals↗
PubMed2000

Distraction osteogenesis after acute limb-shortening for segmental tibial defects. Comparison of a monofocal and a bifocal technique in rabbits.

BACKGROUND: Segmental bone defects can be treated with immediate limb-shortening followed by monofocal or bifocal distraction osteogenesis. In the present study, the efficacy of monofocal distraction osteogenesis was compared with that of bifocal distraction osteogenesis in a rabbit model. METHODS: Twenty-four skeletally mature New Zealand White rabbits were divided into two equal groups: one group had monofocal distraction osteosynthesis, and the other had bifocal distraction osteosynthesis. In both groups, a one-centimeter-long segment of bone was resected from the midpart of the tibial shaft. In the monofocal reconstruction group, the limb was immediately shortened to close the segmental defect and the defect was allowed to heal for ten days. Lengthening was then begun at this site, with use of a specially designed external fixator, at a rate of 0.5 millimeter per twelve hours. In the bifocal reconstruction group, the segmental defect was closed immediately and the fragments were fixed with microplates. A subperiosteal osteotomy was performed proximal to the tibiofibular junction, and lengthening was performed at the site of the osteotomy. The animals in both groups were killed twenty days after the lengthening was completed. New-bone formation then was evaluated with use of radiographs, densitometry, biomechanical testing, and histological and histomorphometric analysis. RESULTS: Osseous consolidation occurred in all but one of the animals. Biomechanical testing demonstrated that the tibiae that had been treated with use of the simple monofocal reconstruction technique tended to have greater torsional stiffness (p = 0.14) and strength (p = 0.09). Follow-up radiographs revealed that both groups had a significant decrease in radiolucent area (p < 0.05), which occurred at essentially the same rate after lengthening. No significant differences were found between the groups with respect to new-bone mineral density, new-bone area, or the amount of callus. Thus, after resection of a diaphyseal bone segment comprising 10 percent of the original length of the tibia and acute shortening, limb reconstruction was completed successfully through distraction osteogenesis with use of either a monofocal or a bifocal technique in rabbits. CONCLUSIONS: In the present study, both monofocal and bifocal techniques of shortening and distraction osteogenesis were effective for the reconstruction of segmental bone defects. Under some conditions, the monofocal method may provide a simpler means of treating such defects. CLINICAL RELEVANCE: Damage to the soft-tissue envelope as well as venous and lymphatic stasis impose limits on the amount of limb-shortening that can be achieved with use of the monofocal method and also influence the indications for this procedure in the clinical setting.

Animals↗
PubMed2002

Transport distraction osteogenesis: a new method to heal adult calvarial defects.

Popularized by Gavril Ilizarov in the 1960s, monofocal distraction osteogenesis has become a well-established method of endogenous bone engineering. This revolutionary surgical technique has significantly augmented the available reconstructive orthopedic and craniomaxillofacial procedures. Bifocal distraction osteogenesis, or bone transportation, is a modification of monofocal distraction that involves moving a free segment of living bone to fill an intercalary bone defect. Bifocal distraction has been applied successfully to reconstruct complex mandibular and long bone defects. Because traumatic or postsurgical calvarial defects do not spontaneously heal in humans older than 18 to 24 months of age, we hypothesized that bifocal distraction osteogenesis could be applied to the skull to close critical size calvarial defects. Critical size (15 x 15 mm) calvarial defects were created in eight New Zealand White rabbits. Next, a 15-mm x 10-mm calvarial box osteotomy was created just anterior to the skull defect. This osteotomy created a free bone segment that could be transported. A custom-made transport distraction device was fixed into place and the skin incision was closed. After a 4-day latency period, the distraction device was activated (0.5 mm once daily for 30 days) in seven animals; the distraction device in one animal was not activated and served as a control. All animals underwent 30 days of consolidation and were then killed. Radiographs and computed tomographic scans were performed at the following time points: end of latency period (postoperative day 4), mid-distraction (postoperative day 19), and end of consolidation period (postoperative day 64). Gross and histologic analysis was performed to evaluate the quality of the bony regenerate. The control animal healed with a fibrous union. Complete closure of the skull defects was observed in five of seven rabbits at the end of the consolidation period. One animal was removed from the study because of an early loosening of the distraction device, and one was removed because of device failure. Of the remaining five animals that completed the distraction protocol, radiographs and computerized tomographic scans showed successful ossification in all five rabbits at the end of the consolidation period. This study suggests that transport distraction osteogenesis is a promising technique that may be applied to a variety of commonly encountered craniofacial problems such as nonhealing calvarial defects.

Age Factors↗
PubMed2000

Introduction of "vario plates" for retention after mandibular distraction osteogenesis.

This report introduces a new removable orthodontic appliance called "vario plates" for retention following distraction osteogenesis of the mandible. The "vario plates" consist of removable orthodontic appliances in the maxilla and the mandible. These are fabricated out of self-curing resin with typical wire elements. They are connected with telescoping maxillomandibular guidance rods, which have a smoothly variable length, from the maxillary molar region to the mandibular premolar region on each side. The telescope on both sides is adjustable in this length by means of a protrusion nut. Thus, it is possible to move the mandible forward an exactly controlled amount. The "vario plates" are in function for 24 hours a day in the patient for the first 6 months after mandibular distraction osteogenesis and subsequently only at night. The application of the plates is demonstrated in a patient with Goldenhar syndrome. Application of "vario plates" after distraction osteogenesis makes it possible to hold the mandible in a stable position. The combination of maxillofacial surgery with distraction osteogenesis and orthodontic treatment and retention leads to an improvement in therapy of patients with severe dentofacial anomalies.

Adult↗
PubMed2001

Combined simultaneous distraction osteogenesis of the maxilla and mandible using a single distraction device in hemifacial microsomia.

Facial asymmetry in hemifacial microsomia can be corrected by an effective procedure of gradual distraction of the mandible. In younger children with deciduous dentition, changes in dental occlusion secondary from mandibular distraction can be easily corrected with orthodontic treatment. In older patients, mandibular elongation through distraction osteogenesis can produce good aesthetics but can create a severe alteration in occlusion requiring complex orthodontic treatment during an extended period. A Le Fort I osteotomy was performed simultaneously with mandibular corticotomy to avoid this problem. We present an 11-year-old patient with grade II hemifacial microsomia with facial asymmetry that was corrected with a combined simultaneous distraction of the maxilla and mandible using a single mandibular distraction device and an interdental splint. Excellent facial symmetry was achieved while maintaining preexisting dental occlusion.

Bone Wires↗
PubMed2004

[mRNA expression of activin a and follistatin in rabbit mandibular distraction osteogenesis].

OBJECTIVE: To examine the mRNA expression of activin A(ACT A) and follistatin(FS) during mandibular lengthening and to elucidate the regulating pattern of during mandibular distraction osteogenesis. METHODS: Skeletally mature white New Zealand rabbits were established right mandibular distraction osteogenesis models and the mandibles were lengthened 7 days after osteomy. At the end of latency period and the end of distraction period, 10, 20, 30, 40 and 60 days after fixation, the regenerating tissue of animals' lengthened mandibles and that of the other side normal mandibles were harvested to extract RNA and to analyse ACT A, FS mRNA by RT-PCR. RESULTS: The expression of ACT A mRNA was not detectable in normal bone tissue and ACT A mRNA began to express at the end of latency period. The expression of ACT A mRNA increased gradually along with the beginning of distraction and reached the peak on the 10th and 20th days of distraction which was 5.04 and 4.98 times as much as that of the end of latency period, respectively. The trend of expression of FS mRNA during mandibular distraction osteogenesis was the same as expression of ACT A mRNA. CONCLUSION: ACT A/FS play an important role during rabbit mandibular distraction osteogenesis. To examine the mRNA expression of activin A(ACT A) and follistatin(FS) during mandibular lengthening and to elucidate the regulating pattern of during mandibular distraction osteogenesis.

Activins↗
PubMed1997

Distraction osteogenesis of costochondral neomandibles: a clinical experience.

Distraction osteogenesis quickly has become a mainstay in the treatment of craniofacial syndromes with mandibular hypoplasia. We report on a series of eight patients undergoing distraction osteogenesis of neomandibles constructed with costochondral grafts. The length of distraction, resting phase between distraction and device removal, and complication rate were significantly greater in the rib-graft distraction group when compared with our series of native mandibular distraction patients (n = 21 devices). Most complications were minor, including pintrack infection and hardware failure; however, major complications included fibrous union and facial nerve praxia. Secondary procedures have been able to be performed successfully on previously distracted rib grafts as well.

Adolescent↗
PubMed2005

[Distraction osteogenesis in patients with syndromic midface retrusion--a primary experience].

OBJECTIVE: To study the feasibility of midface distraction for correction of severe syndromic Four consecutive patients with severe syndromic midface retrusion underwent midface retrusion. METHODS: distraction osteogenesis. The patients(three girls and one boy) aged from 4 to 12 years. Two were with Crouzon syndrome, one with Apert and one with Marfan syndrome. One was treated with Le Fort III external distraction, two with Le Fort III internal distraction, and the other with monobloc internal distraction. The distraction devices were activated on the fourth postoperative day at 1 mm per day. RESULTS: All patients completed the distraction as activated on the fourth postoperative day at 1 mm per day. Results was planned. Successful advancement of 8 to 20 mm was obtained at the occlusal level in all patients as measured by cephalograms. The facial appearance was significantly improved,especially in the orbits and the upper part of the nose. Follow-up from 4 months to one year demonstrated that the face was symmetrical. All patients obtained This study shows that although midface distraction osteogenesis needs to be satisfactory results. CONCLUSIONS: This study shows that although midface distraction osteogenesis needs to be improved to increase its controllability, it has obvious advantages over the traditional way of bone graft and rigid fixation. Midface distraction avoids bone grafts and alleviates the restriction of the soft tissue to midfacial bone advancement. Midface distraction osteogenesis is an effective and practical way to correct severe syndromic midfacial hypoplasia.

Australia↗
PubMed2003

Complications in bilateral mandibular distraction osteogenesis using internal devices.

OBJECTIVE: We sought to evaluate the possibility of distraction osteogenesis as an alternative to conventional bilateral sagittal split osteotomy. Complications (intraoperative, intradistraction, and postdistraction) were evaluated retrospectively. STUDY DESIGN: Seventy consecutive patients (40 males and 30 females, 11.2-37.3 years old; mean, 14.2 years) underwent distraction osteogenesis to lengthen the mandible. The surgical procedure was carried out with the patient under general anesthesia. After the osteotomy was performed, 2 intraoral monodirectional distraction devices were placed on the mandibular cortex in the third molar region. The rate of distraction was 1 mm/day. The different complications encountered during all phases of the distraction procedure were recorded. RESULTS: A total of 28 complications (40%) were recorded. In 10 patients (14.3%), the complications were technique- or device-related, or both, and occurred early in the learning period. Five patients (7.1%) had infection occur, and 3 patients (4.3%) had prolonged sensory loss in the distribution of the alveolar nerve. Severe complications occurred in 6 patients (8.6%). Rehospitalization was necessary in 5 patients (7.1%), 4 of whom (5.7% of the series) required further surgery under general anesthesia. CONCLUSION: Distraction osteogenesis can be considered a safe and predictable procedure for lengthening the mandible, with a low incidence of major complications. The infection rate and the incidence of damage to the inferior alveolar nerve (2.1%) are low. Compliance of both patients and parents during the whole treatment period is of the utmost importance.

Adolescent↗
PubMed2004

Positional and morphologic changes of the mandibular condyle after mandibular distraction osteogenesis in skeletal class II patients.

AIM: Mandibular distraction osteogenesis has been used to correct the skeletal problems in patients with severe mandibular deficiency. Short-term effects of mandibular distraction osteogenesis on condylar position, condylar morphology, and temporomandibular joint symptoms in patients with severe skeletal Class II malocclusions were evaluated. MATERIAL AND METHODS: The records of 13 patients who had undergone bilateral mandibular lengthening and/or midline mandibular widening were analyzed. Pre- and postoperative positional changes of the mandibular condyle in the glenoid fossa, the axial rotation of the condylar head, and the temporomandibular joint symptoms were evaluated. RESULTS: Most of the condyles were displaced in an upward and backward direction in the glenoid fossa; the amount correlated with the amount of mandibular lengthening. Resorption was observed in 20% of condyles; the incidence of the resorption correlated with incidence of preoperative articular disc displacement and with the amount of condylar displacement. CONCLUSION: Distraction protocols should be performed with particular attention when patients with articular disc displacement require a large amount of distraction.

Adolescent↗
PubMed2003

Distraction osteogenesis in correction of micrognathia accompanying obstructive sleep apnea syndrome.

To evaluate the effect of distraction osteogenesis in correction of micrognathia accompanying obstructive sleep apnea syndrome, a total of 28 patients with different severities of obstructive sleep apnea syndrome underwent mandibular distraction osteogenesis. A total of 51 distraction devices were placed for bilateral distraction in 23 patients and for unilateral distraction in five patients. The mean age of patients was 21.2 years (range, 3 to 60 years). Eleven patients had micrognathia accompanying obstructive sleep apnea syndrome secondary to bilateral temporomandibular joint ankylosis, and 10 patients had micrognathia accompanying obstructive sleep apnea syndrome secondary to unilateral temporomandibular joint ankylosis. Three patients had developmental micrognathia accompanying obstructive sleep apnea syndrome. The other four patients had micrognathia and concomitant obstructive sleep apnea syndrome induced by trauma, infection, or tumor resection. Each patient had been evaluated preoperatively and postoperatively with cephalometry and polysomnography. Mandible advancement ranged from 9 to 30 mm (average, 20.4 mm) and was successfully achieved after distraction. Fine new bone formed in the distraction gap when the distraction devices were removed 3 to 4 months after distraction was completed. No infection or other complications occurred in any patients. Complete curative effects were achieved in nine severe, six moderate, and eight mild obstructive sleep apnea syndrome patients after distraction, and the other five patients had been improved to the mild level. After distraction was completed, the posterior airway space was increased on average from 4.6 mm to 12.5 mm and the sella-nasion-point B angle was increased on average from 66 degrees to 75 degrees on cephalometric studies. The polysomnographic examination showed that the apnea hypopnea index was lowered on average from 58.0 to 3.15, and the lowest oxygen saturation was increased on average from 77 percent to 90.3 percent after distraction was completed. The follow-up period was 3 to 61 months (average, 18.1 months). The curative effect was stable and no relapse occurred. Therefore, the authors conclude that mandibular distraction osteogenesis is an effective method for correcting micrognathia accompanying obstructive sleep apnea syndrome. Compared with other current routine surgical procedures, it has many advantages, such as low risk, simple manipulation, high curative rate, low relapse rate, and stable result. It is presently the most effective method for the treatment of this difficult and complicated disorder.

Adolescent↗
PubMed2005

Stem cells and distraction osteogenesis: endothelial progenitor cells home to the ischemic generate in activation and consolidation.

BACKGROUND: Ischemia is a limiting factor during distraction osteogenesis. The authors sought to determine the extent of ischemia in the distraction zone and whether endothelial progenitor cells home to the distraction zone and participate in local vasculogenesis. METHODS: Laser Doppler imaging was used to assess the extent of blood flow in the distraction zone in gradually distracted, immediately distracted, and osteotomized rat mandibles during activation and consolidation. Animals (n = 50; 25 rats with unilateral gradual distraction and contralateral osteotomy as an internal control, and 25 rats with unilateral immediate distraction) were examined on postoperative days 4, 6, and 8 of activation, and after 1 and 2 weeks of consolidation. Endothelial progenitor cells isolated from human peripheral blood were labeled with fluorescent DiI dye, and 0.5 x 10 cells were injected intra-arterially under direct vision into each carotid artery at the start of activation in nude rats (n = 18) that then underwent the distraction protocol outlined above. RESULTS: Doppler flow analysis demonstrated relative ischemia during the activation period in the distraction osteogenesis group and increased blood flow in the osteotomized control group as compared with flow in a normal hemimandible [normal, 1 (standardized); distraction osteogenesis, 0.58 +/- 0.05; control, 2.58 +/- 0.21; p < 0.05 for both results]. We observed a significantly increased endothelial progenitor cell population at the generate site versus controls at midactivation and at 1 and 2 weeks of consolidation [25 +/- 1.9 versus 1 +/- 0.3 DiI-positive cells per high-power field (p < 0.05), 124 +/- 21 versus 8 +/- 4 DiI-positive cells per high-power field (p < 0.05), and 106 +/- 18 versus 9 +/- 3 DiI-positive cells per high-power field (p < 0.05), respectively]. CONCLUSIONS: These data suggest that the distraction zone becomes relatively ischemic during activation and that endothelial progenitor cells home to the ischemic generate site during the activation phase and remain during the consolidation phase. Selective expansion of these stem cells may be useful in overcoming ischemic limitations of distraction osteogenesis. Moreover, their homing capability may be used to effect site-specific transgene delivery to the generate.

Animals↗
PubMed2001

[The management of anterior transversal mandibular deficiencies by distraction osteogenesis. Preliminary results and report of 3 cases].

During the last ten years, osteodistraction genesis appeared as being a treatment of some maxillo-facial transversal deficiencies. A new technique have been develop in Lille Maxillo-Facial Department (Pr Ferri, France). This new technique is used in cases of mandibular hyposymphysis, which induce most of the time a mandibular incisor crowding. This distraction osteogenesis performed after sagittal osteotomy of the mandibular symphysis and associated with orthodontic treatment is a solution to avoid teeth extractions. Other treatments could be used to solve anterior mandibular teeth crowding but they have disadvantages: teeth slicing, teeth extraction or orthodontic teeth tilting. This new technique is performed with intra oral-device, small enough to be placed under mandibular periosteum. Three patients have been treated by this technique, they got a stable result. In these three cases, alveolar and basal bone is present. So for us, symphysis osteogenesis distraction appears to be an alternative treatments to mandibular incisor crowding.

Adolescent↗
PubMed1997

Distraction osteogenesis for lengthening of the hard palate: Part II. Histological study of the hard and soft palate after distraction.

To correct velopharyngeal incompetence, a new treatment concept was proposed in Distraction Osteogenesis for Lengthening of the Hard Palate: Part I (using lengthening of the hard and soft palate by distraction osteogenesis). Cephalometry and computed tomography showed successful elongation of the posterior hard palate with gradual calcification. Here the sequential use of fluorochrome markers (oxytetracycline, xylenol orange, DCAF [2,4-bis-N-N'-dicarboxymethyl aminomethyl fluorescein], and alizarin complexone) during the distraction and retention period is reported together with the histologic investigations using light and laser scan microscopy without prior demineralization. The experimental gap showed de novo osteogenesis in all dogs. The new bone was always in continuity with the original anterior and posterior palatal bone margins. It either bridged the experimental gap fully or left a small central zone of fibrous tissue, in which eventual ossification occurred. Several distinct zones could be distinguished: A small central zone was found with parallel strains of collagen fibers, oriented longitudinally in the direction of the distraction. Next to this zone a layer of undifferentiated mesenchymal precursor cells was seen in direct contact to newly formed bone. The next zone was coarse woven bone, showing a transition to mature lamellar bone through remodeling. No evidence of endochondral bone formation was found, i.e., all dogs showed exclusively intramembranous bone formation. The soft tissues showed no signs of alteration: in particular, there was no necrosis or scar formation. The soft tissues were not thinned but appeared to have followed the longitudinal displacement. In conclusion, gradual distraction osteogenesis of the hard palate could be a possible method for lengthening the palate to treat velopharyngeal incompetence.

Animals↗