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PubMedDate not supplied

Repeated distraction osteogenesis for excessive vertical alveolar augmentation: a case report.

In this article, a procedure involving 2-stage alveolar distraction osteogenesis using eccentric distraction devices for the augmentation of resorbed transplanted iliac bone following mandibular tumor resection is presented. A 6-month consolidation period was allowed between the first and second distractions, and endosseous implants were placed 4 months after the second distraction. Computerized tomographic images obtained before the implantation revealed that, 10 months after the first distraction, the bone generated still showed lower density compared with the basal bone, but the bone from both distractions showed enough maturity for implantation. It may be concluded that 2-stage alveolar distraction osteogenesis can be a useful and safe procedure for excessive alveolar lengthening if a sufficiently long consolidation period is allowed.

Adult↗
PubMed1999

Mechanical tension-stress induces expression of bone morphogenetic protein (BMP)-2 and BMP-4, but not BMP-6, BMP-7, and GDF-5 mRNA, during distraction osteogenesis.

Bone lengthening with osteotomy and gradual distraction was achieved in 57 rats, and the effect of mechanical tension-stress on gene expression of bone morphogenetic proteins (BMPs) was investigated by in situ hybridization and Northern blot analysis using probes of BMP-2, BMP-4, BMP-6, BMP-7, and growth/differentiation factor (GDF)-5. There was a lag phase for 7 days after femoral osteotomy until gradual distraction was carried out for 21 days at a rate of 0. 25 mm/12 h using a small external fixator. The signals of the above BMPs mRNA were not detected in the intact rat bone but they were induced after osteotomy except those for BMP-7. By 4 days after osteotomy, BMP-2 and BMP-4 mRNAs were detected in chondrogenic precursor cells in the subperiosteal immature callus. BMP-6 and GDF-5 mRNA were detected in more differentiated cells in chondroid bone. By 7 days after osteotomy, cartilaginous external callus and bony endosteal callus were formed. Meanwhile, the signals of BMP-2 and BMP-4 mRNAs declined to preoperative levels, whereas the signals of BMP-6 and GDF-5 mRNAs were rather elevated. As distraction was started, the callus elongated and eventually separated into proximal and distal segments forming a fibrous interzone in the middle. Expression of BMP-2 and BMP-4 mRNAs was markedly induced at this stage. Their signals were detected widely among chondrogenic and osteogenic cells and their precursor cells sustaining mechanical tension-stress at the fibrous interzone. BMP-6 and GDF-5 mRNAs were detected exclusively in chondrogenic cells at both ends of the fibrous interzone, where endochondral ossification occurred. But neither mRNA was detected in terminally differentiated hypertrophic chondrocytes. As distraction advanced, the cartilage was progressively resorbed from both ends and new bone was formed directly by intramembranous ossification. There was no new cartilage formation in the advanced stage of distraction. The signals of BMP-6 and GDF-5 mRNA declined by this stage, while those of BMP-2 and BMP-4 were maintained at high level for as long as distraction was continued. After completion of distraction, the fibrous interzone fused and the lengthened segment was consolidated. BMP-2, BMP-4, BMP-6, nor GDF-5 was expressed at this stage. The signals of BMP-7 were not detected throughout the experiment. The present results suggest that excellent and uninterrupted bone formation during distraction osteogenesis owes to enhanced expression of BMP-2 and BMP-4 genes by mechanical tension-stress. Abundant gene products of BMP-2 and BMP-4 could induce in situ bone formation by paracrine and autocrine mechanisms.

Animals↗
PubMed2006

[Distraction osteogenesis in the head and neck region].

Distraction osteogenesis is used in oral and maxillofacial surgery for the purpose of lengthening or widening an upper or lower jaw or to reposition the jaw to such an extent as cannot be achieved with normal osteotomy. This technique moves the parts of an osteomised bone slowly apart. Subsequently, new trabecular bone growth occurs between the separate bone parts that is then turned into bone with a normal mineralised architecture. Extraoral distractors can be fitted, activated, positioned and removed fairly easily. Distractors for intraoral placement do not cause any extraoral scars and are less burdensome in their daily use. Some distractors can impede access to the larynx and the trachea. For elective surgical procedures, the accessibility of the larynx can be judged with a laryngoscope for the induction and ending of anaesthesia. Should the intraoral or extraoral distractors form any obstruction in this process, then they should be removed. The alternatives are fibroscopic intubation and emergency tracheotomy.

Bone Regeneration↗
PubMed2006

[Experiment of using distraction osteogenesis to repair skull defect].

OBJECTIVE: To explore the possibility of using distraction osteogenesis to repair skull defect. METHODS: 17 goats with one year age were chosen randomly. The animals were divided to 3 groups. Group A includes 7 goats, a 3.0 cm x 2.2 cm rectangle skull defect is created on both sides of parietal area. Group B includes 5 goats, a 2.2 cm x 2.2 cm square skull defect was created on right side of parietal area. Group C includes 5 goats, a 3 cm x 1 cm rectangle skull defect was created on both sides of parietal area. Accordingly, different size of transport discs were created on right side of skull and the distraction apparatus is implanted. 3-D CT was done to measure the skull defect on group A. Biomechanical test was done on group B. Process of bone formation illustrated by histological stain, scan and transparent electric microscope was observed on group C. RESULTS: Group A measured by 3-D CT showed that skull defect of experimental side have been repaired by distraction osteogenesis. There was definitely difference between experimental and control side (P < 0.01). Group B measured by biomechanical test showed no definitely difference between experimental and normal side (maximum load P = 0.235 > 0.05, rigidity P = 0.213 > 0.05). Group C showed that the process of bone formation was typical intramembranous. CONCLUSIONS: The evidence showed that skull defect of goat can be repaired by distraction osteogenesis.

Animals↗
PubMed1997

Trifocal distraction osteogenesis for segmental mandibular defect: a technical innovation.

Distraction osteogenesis in the mandible is a promising method, not only for correction of mandibular hypoplasia such as hemifacial microsomia, but also for reconstruction of segmental bone defects in the mandible. The authors report a case in which a mandibular segmental defect, about 60 mm in length, was reconstructed by distraction osteogenesis. The patient was a 45-year-old man who had been treated for an oral floor cancer. After preoperative chemotherapy and irradiation therapy, the mandible had been resected from the second incisor on the right side to the first molar on the left side, and had been reconstructed with a titanium plate and a vascularized rectus-abdominis compound flap. However, an infection developed around the titanium plate and this plate had to be removed. Therefore, trifocal distraction using an original three-dimensional distractor was performed, at the rate of 1 mm per day (0.5 mm in the morning and 0.5 mm in the evening). During the distraction period, the skin flap was pushed out from the bone defect. Although small free bone transplants were needed for complete continuity, the segmental bone defect was almost filled by the regenerated bone with the lengthened gingiva. Radiographic observation showed successful new bone formation in the lengthened area.

Bone Plates↗
PubMed2000

[Management of micrognathia deformity associated with obstructive sleep apnea syndrome by distraction osteogenesis].

OBJECTIVE: To review the early results of lengthening of the mandible by distraction osteogenesis for the correction of micrognathia deformity and treatment of the obstructive sleep apnea syndrome (OSAS) simultaneously. METHODS: 5 cases with micrognathia deformity associated with OSAS resulted from unilateral/bilateral temporomandibular joint ankylosis had undergone mandibular distraction osteogenesis. In all of the patients intraoral device was employed. Cephalometric radiographs and polysomnograms were obtained preoperatively and postoperatively. RESULTS: The average distraction distance was 15.28 mm (range 8.5 mm to 24.4 mm). The micrognathia deformity was corrected effectively, at the mean time the incapacious pharyngeal airway was ameliorated. The patients' Apnea Index (AI) had been decreasing, SaO(2) during sleep had got to rise. CONCLUSIONS: Compared with the traditional surgery for the micrognathia associated with OSAS, the technique of mandibular distraction osteogenesis has the advantages of avoiding bone grafting and donor side morbidity, expanding the surrounding soft tissue concurrently, reducing the extent of operation and stability of the treatment effects.

Adolescent↗
PubMed2006

[Simultaneous occlusal orthodontics during mandibular distraction osteogenesis].

OBJECTIVE: To study the significance and principle of simultaneous orthodontics during mandibular distraction osteogenesis. METHODS: Totally 11 patients simultaneously underwent occlusal orthodontic treatment for 3-4 months during mandibular distraction osteogenesis. Square-wire and elastic loops were adapted to perform the orthodontics by ways of more frequent adjustment of orthodontic device than routine method. RESULTS: All 11 patients with mandibular micronathia obtained the improved occlusion with their mandibular expected elongation, for instance, their open-bite and teeth displacement were partially corrected. CONCLUSION: Simultanous orthodontics with mandibular distraction osteogenesis may improve the malocclusion, decrease the orthodontic time, and lead the mandibular distraction direction.

Adolescent↗
PubMed1998

[Distraction osteogenesis. A new development in craniofacial surgery].

By means of distraction osteogenesis (callus distraction) it is possible to reshape bone by creating stress across an iatrogenic fracture line. Subsequent to the successful use of this method in orthopaedic surgery, the development of small intra-oral distractors has opened up the possibilities for its application in maxillo-facial surgery, and the correction of orthodontic and dental problems. Following corticotomy and the fixing of the distractor, it is usually possible to begin adjustment on the fifth post-operative day. Adjustment of the distractor twice a day results in a daily distraction of 1 mm. Both congenital and acquired deformities can be corrected in this way. Class II-1 malocclusion can be corrected by simultaneous bilateral distraction. It is concluded that distraction would seem to have a place in maxillo-facial surgery.

Facial Bones↗
PubMed2005

Effective maxillary orthopedic protraction for growing Class III patients: a clinical application simulates distraction osteogenesis.

The effective maxillary orthopedic protraction is an innovative technique for maxillary protraction in Class III growing patients. It includes three components: a new 2-hinged rapid maxillary expander for a greater amount of anterior displacement of maxilla, repetitive weekly protocol of Alternate Rapid Maxillary Expansion and Constriction (Alt-RAMEC) for disarticulating the maxilla, and intraoral maxillary protraction springs for non-compliant protraction. On average, the maxilla could be protracted for 5.8 mm in 3 months and the result remains stable at least 2 years later. The rationale for this technique is sutural expansion/ protraction osteogenesis. Sutural expansion/ protraction osteogenesis is a form of distraction osteogenesis. However, it still needs to be scrutinized experimentally for the sutural reactions corresponding to the effective maxillary orthopedic protraction.

Humans↗
PubMed2000

The adaptation of perimuscular connective tissue during distraction osteogenesis.

It is not known whether the decreased range of motion observed during distraction osteogenesis results from the lack of adaptation of muscle or from fibrosis in the perimysium. The adaptation of the perimysium in the tibialis anterior muscle in skeletally immature rabbits using two distraction regimens (0.7 and 1.4 mm/day with 15% lengthening) was characterized. The resulting data indicate that during distraction osteogenesis, the muscle adapts by reorganization of its connective tissue. At a lengthening rate of 1.4 mm/day, there is perimysial fibrosis without major cellular pathologic abnormalities in the muscle fibers. The increase in perimysial thickness is characterized by an increase of collagen Type I. In addition, collagen Type I is deposited around the endomysium. The increase in total collagen and its cross-linking are dependent on the lengthening rate. The faster lengthening rate also leads to a significant decreased passive plantar flexion. Supplemental growth of the tibia was not observed, and a lack of adaptation in the muscle (based on resting length) was not seen. Together, the data suggest that decreased range of motion during distraction osteogenesis may be a function of the adaptation of the perimysium rather than of the muscle fibers.

Adaptation, Physiological↗
PubMed2004

Distraction osteogenesis in Pierre Robin neonates with airway obstruction.

Mandibular distraction osteogenesis can be a safe and effective way to avoid tracheostomy placement in selected neonates with Pierre Robin sequence,with or without other associated syndromes. In non-syndromic Pierre Robin sequence syndromes, this procedure, in the current author's experience, has provided definitive correction of both airway obstruction and micrognathia. The cost to patients and families appropriately treated by mandibular distraction osteogenesis is substantially less than tracheostomy. Mandibular distraction does not involve the ongoing maintenance, medical care, and high risk of mortality associated with tracheostomy. A support team of pediatric anesthesia, pulmonary, and otolaryngology specialists is required for the safe and successful selection and treatment of this group of patients with Pierre Robin sequence using mandibular distraction. The author's investigation of this group is ongoing.

Airway Obstruction↗
PubMed1994

Distraction osteogenesis in the irradiated canine mandible.

The potential use of distraction osteogenesis in mandibular reconstruction has been limited by its questionable efficacy in previously radiated bone. We studied five mongrel dogs that had a hemimandible rendered edentulous and underwent a full course of external beam radiation therapy (50 Gy/20 fractions). Six months after completion of radiotherapy, a 2-cm critical-size segmental mandibular defect was created and stabilized with a stainless steel plate. A proximal mandibular transport segment was then formed and an external lengthening apparatus (Orthofix) applied. By means of bifocal distraction osteogenesis, the defects were filled with new bone in a period of 30 days in four of five dogs. Histologic analysis and fluorochrome microscopy confirmed the formation of new cortical bone. Our results suggest that distraction osteogenesis is successful in previously radiated bone and that it may be a simple method of mandibular reconstruction following ablative head and neck surgery.

Animals↗
PubMed1997

Distraction osteogenesis: its application in severe mandibular deformities in hemifacial microsomia.

The reconstruction of severe mandibular deformities in patients with hemifacial microsomia (HFM) is difficult. The multiple requirements include temporomandibular joint construction, mandibular ramus and body reconstructions with autogenous bone grafts, and soft tissue facial augmentation. The sequencing of these reconstructions include staged procedures, generally performed at the time of skeletal maturity. Mandibular distraction osteogenesis has gained popularity as a technique for managing patients with mandibular hypoplasia. However, the use of distraction osteogenesis in HFM patients with severe grade III mandibular deformities has not been previously addressed. The purpose of this report is to present our early findings with the clinical application of mandibular distraction osteogenesis in HFM patients with grade III mandibular deformities. In selected patients, mandibular distraction osteogenesis can be beneficial by improving overall facial symmetry and balance. Mandibular distraction osteogenesis has unique advantages for these patients in that it can be performed early in childhood with minimal morbidity. Through the use of clinical examples, the application, patient selection, and advantages and disadvantages of mandibular distraction osteogenesis in HFM patients with grade III mandibular deformities are discussed.

Adolescent↗
PubMed2004

Mandibular widening by distraction osteogenesis in the treatment of a constricted mandible and telescopic bite.

OBJECTIVE: Documentation of the application of mandibular widening by distraction osteogenesis and orthodontics. PATIENTS: Three patients with telescopic bite resulting from an extremely constricted mandible related to hypoglossia-hypodactyly syndrome. INTERVENTION: Mandibular widening by distraction osteogenesis using an extraoral device and subsequent orthodontic treatment. RESULTS: The extremely constricted mandible and telescopic bite were dramatically improved by mandibular widening using distraction osteogenesis and subsequent orthodontics. Two of the three patients had transient complications; one reported temporomandibular joint pain and the other showed evidence of periodontal damage. CONCLUSION: Mandibular widening by distraction osteogenesis is an effective technique for the treatment of telescopic bite resulting from an extremely constricted mandible.

Child↗
PubMed1999

Biologic model of bone transport distraction osteogenesis and vascular response.

We developed an experimental model in the rabbit of distraction osteogenesis through bone transport that closely corresponds to the clinical use of bone transport in humans. We also applied injection angiography to study the arterial response of a limb undergoing bone transport. This model includes a proximal osteotomy and bone transport to fill in a segmental tibial diaphyseal defect. Regenerate bone formed well in the gap that was created that trailed the transport segment, and slow healing at the docking site was observed, as seen in humans. The angiographic techniques clearly revealed, by radiography and anatomic dissection, the arterial response to bone transport. The results showed that the transport segment had an arterial supply after osteotomy and after transport. They also demonstrated an extensive increase in vessels in limbs that had undergone distraction osteogenesis, an observation made clinically in humans but not well demonstrated experimentally. Furthermore, angiography showed proximal stretching and distal kinking of the major artery of the leg. This model closely resembles distraction osteogenesis through bone transport in humans and definitively demonstrates that the transport segment can maintain blood supply and remain viable during the transport process. The results of this study provide a basis for further work on factors that enhance and interfere with successful bone transport in humans.

Angiography↗
PubMed1994

Multidimensional distraction osteogenesis: the canine zygoma.

The principle of distraction osteogenesis, well-established in the enchondral bones of the axial skeleton, has recently been applied to the membranous bones (mandible, cranium) of the craniofacial skeleton in the experimental animal and in the human. In the craniofacial skeleton, however, the technique has been used only to lengthen bone in a direction along its major axis, i.e., unidimensional distraction. A canine model is presented to demonstrate the feasibility of distracting membranous bone away from its dominant axis, i.e., multidimensional distraction. Four mongrel dogs, 5 months of age, were the subjects of this study. Two osteotomies were made in the zygomatic arch, and the bone-lengthening device was fixed to the zygoma. After 7 days of external fixation, the osteotomized segment was lengthened 1 mm/day away from the long axis of the bone for 15 days. External fixation was then maintained for a minimum of 4 weeks, after which the dogs were sacrificed. Craniofacial CT with three-dimensional reconstruction documented multidimensional bone lengthening, and histologic analysis of the specimen confirmed the presence of new cortical bone in the expanded areas. Refinement in technique and miniaturization and internalization of the bone-lengthening device may allow for more precise changes in the amount and direction of lengthening, thus making distraction osteogenesis more widely applicable for use in the human craniofacial skeleton.

Animals↗
PubMed2006

[Segmental reconstruction of maxillary defects by arced distraction osteogenesis of zygoma].

OBJECTIVE: To study the possibility of segmental maxillary regeneration by arced distraction osteogenesis of zygoma. METHODS: The distraction of zygoma with the internal arced devices was performed in 2 dogs to simulate the reconstruction of maxillary defect. The zygoma was distracted about 12 mm, and the process of new bone formation was studied by histology and scanning electron microscopy. RESULTS: The transport disk was distracted about 12 mm around the arc. After 8 weeks of consolidation, the density of new bone was close to that of normal bone. CONCLUSIONS: The segmental maxillary regeneration by arced distraction osteogenesis of zygoma is possible.

Animals↗
PubMed2000

[Distraction osteogenesis for correction of maxillary constriction].

OBJECTIVE: To study the methods and effects of distraction osteogenesis for correction of maxillary constriction. METHODS: 10 cases (5 males, and 5 females, aged 16-33 years, average 19.6) were treated by distraction osteogenesis for correction of maxillary constriction. Le Fort I osteotomy and palatal suture osteotomy for the upper jaw were made before opening of the Hyrax screw expander. Totally four times of opening the screw a day were performed. 2 cases were expanded unilaterally. The AP head films were analyzed using Image and Database Analysis System (IDAS) before and after expansion. RESULTS: 1. Expansion of upper arch was achieved done within a few days, and the maxilla, maxillary dental base and the posterior teeth were expanded as much as 3.84 mm, 3.25 mm, and 5.61 mm respectively. 2. The new bone was formed between the opened suture in two weeks, and filled the suture in 2 to 3 months. 3. Maxillary teeth tipped bucally a little bit. CONCLUSIONS: Distraction osteogenesis rapid maxillary expansion could get a good result following Le Fort I and palatal suture osteotomy for correction of maxillary constriction.

Adolescent↗