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At least 685 records · Page 38Linked to original sources
PubMed2004

Effects of maxillary distraction osteogenesis on the upper-airway size and nasal resistance in subjects with cleft lip and palate.

OBJECTIVES: To investigate the short- and long-term effects of maxillary distraction osteogenesis (DOG) on the upper-airway size and nasal resistance in nine patients with cleft lip and palate (CLP). STUDY DESIGN: Changes in the upper-airway size were measured by using lateral cephalometric radiographs taken immediately before and after DOG, and 1 year later. Nasal resistance was measured with a rhinomanometer. An analysis of variance was used to establish statistical significance. Spearman correlation coefficient was used to evaluate the relationship between changes in the cross-sectional area of the upper airway and nasal resistance in association with DOG. RESULTS: Immediately after DOG, the anteroposterior dimension of the superior part of the upper airway was significantly increased (p < 0.01) and nasal resistance was significantly decreased (p < 0.05). Moreover, the cross-sectional area of the total upper airway was significantly increased (p < 0.01). There was a significant correlation between the increase in the upper-airway cross-sectional area and the reduction in nasal resistance (p < 0.05). The upper-airway size was significantly augmented (p < 0.05) and nasal resistance was significantly reduced (p < 0.05) at 1 year after DOG compared with immediately before DOG. CONCLUSION: An increase in the upper-airway size and a reduction in nasal resistance occurred after maxillary DOG in patients with CLP, and these changes were stable after 1 year.

Adolescent↗
PubMed1998

Distraction osteogenesis of the mandible with a modified intraoral appliance: a pilot study in miniature pigs.

The purpose of this study was to evaluate an intraoral, nontooth-borne, submucosal distraction appliance in the pig mandible from a clinical, radiographic, and histologic perspective. Intraoral distraction appliances were fabricated, tested for strength, and then adapted and rigidly fixated to the mandibles of three growing miniature Yucatan pigs. A bicortical osteotomy was performed on the right side of the mandible, and a buccal and lingual corticotomy on the left. Two amalgam markers were placed on each side of the osteotomy/corticotomy sites as references. Measurements were taken to evaluate the length and vector of the distraction site, and radiographs were obtained perioperatively. After a latency period of 5 days, distraction was commenced and continued for 13 days at a rate of 1 mm/day. Clinical evidence of distraction was apparent in all cases, with resulting Class III skeletal deformities. Distraction progressed further for the corticotomy sides than the osteotomy sides because of distraction device failure. Radiographic examination revealed increased bone density at the periphery of the distracted callus, with less density apparent centrally. Histologic examination showed fibrous connective tissue in the center of the callus, with cartilage and osteoid formation at the periphery. Bone formation was parallel to the vectors of distraction in all cases. This study confirms that the use of a modified intraoral appliance for distraction osteogenesis is feasible. Use of this device overcomes many of the problems associated with extraoral devices and may have clinical applications.

Animals↗
PubMed2003

Distraction osteogenesis of the mandible with an internal bioresorbable device.

Lengthening of the mandible by distraction osteogenesis has been shown to be an effective treatment of hypoplastic mandibles. Use of an internal technique with a bioresorbable distraction device is presented. Mandibular lengthening was performed in seven patients aged 3.2 to 7 years. Six of the patients were diagnosed with craniofacial microsomia, anthe buccal aspect of the mandible, and distraction was started on the second postoperative day at the rate of d one was diagnosed with Nager syndrome. An internal bioresorbable device was placed along 1 mm/d and continued for 17 to 20 days. The distractor screw was maintained for retention for an additional 6 weeks and was then removed. All the patients showed clinical improvement. The postdistraction craniofacial computed tomography scans demonstrated elongation of the mandible with increase in the bony mass. The complications included device failure in one patient. The advantage of this method compared with the internal metal device is that it does not necessitate an additional procedure for device removal.

Absorbable Implants↗
PubMed2005

Relapse in alveolar distraction osteogenesis: an indication for overcorrection.

PURPOSE: The aim of this study was to indicate the necessity of overcorrection regarding the occurrence of bone height relapse at the end of consolidation period in distracted alveolar bone. MATERIALS AND METHODS: Eleven patients with a total of 17 distractions performed and 43 implants placed were included in this study. Bone height was evaluated on computed tomography before the procedure and on orthopantomographic radiographs following distraction and consolidation. Measurement was performed on the aproximal surfaces of implants and on identical points before and after distraction. RESULTS: The mean of distraction performed was 6.08 +/- 1.82 mm at mesial points and 6.18 +/- 1.90 mm at distal points of measurement. The mean of bone relapse following consolidation period was 1.57 +/- 1.82 mm at the mesial and 1.79 +/- 1.68 mm at the distal aspects of implants. Statistical evaluation revealed that alveolar bone distraction should include 20% of overcorrection for both mesial and distal points of measurements plus 0.34 mm for mesial and 0.52 mm for distal points of measurement. CONCLUSIONS: Occurrence of relapse found in this study indicates that overcorrection should be included when performing alveolar distraction osteogenesis.

Adult↗
PubMed2003

Expression of bone morphogenetic proteins during mandibular distraction osteogenesis in rabbits.

PURPOSE: We examined the expression pattern of bone morphogenetic proteins (BMPs) during mandibular distraction osteogenesis in rabbits and also investigated the mechanism of membranous bone distraction. MATERIALS AND METHODS: Twenty-three rabbits underwent mandibular distraction (protocol; no latency period, a 1-week distraction at 0.5 mm/d, and a 2-week consolidation period). Samples were collected at 3, 5, and 7 days of distraction and at 1-week and 2-week consolidation. We prepared undecalcified fresh-frozen sections and immunohistochemically evaluated the expression of BMPs 2 through 8. RESULTS: Both endochondral ossification and intramembranous ossification were observed. The expression of BMPs 2, 4, 5, and 6 was observed continuously from the beginning of distraction. BMP-7 was expressed weakly. The expression of BMP-3 was not observed conspicuously during distraction but was strongly expressed at 1- and 2-week consolidation. CONCLUSION: The expression pattern of BMPs during membranous bone distraction was similar to that during long bone distraction, but it differed from the expression pattern of long bone distraction in that the expression of BMPs was maintained for 2 weeks after the completion of distraction.

Animals↗
PubMed2005

Maxillary distraction osteogenesis to treat maxillary hypoplasia: comparison of an internal and an external system.

BACKGROUND: Distraction osteogenesis (DO) has become a mainstream surgical technique for patients with jaw deformities. In cases of maxillary hypoplasia, DO with a rigid external distraction (RED) system has been used for maxillary advancement; however, DO with internal devices is currently popular. MATERIALS: This article describes DO with an internal device and a RED system in 2 patients with maxillary hypoplasia with oligodontia. The first patient, a young girl, had a concave profile due to maxillary hypoplasia and 9 congenitally missing permanent teeth. At age 11 years 11 months, she received DO with an internal device. The second patient, a boy aged 11 years 7 months, was treated with DO with a RED system. RESULTS: In the girl, the maxilla was advanced 5.0 mm without any dentoalveolar compensation. In the boy, the maxilla was advanced 7.0 mm, but undesirable mesial movement of posterior teeth was observed. CONCLUSIONS: DO with internal devices is simpler and more useful than the RED system for maxillary hypoplasia with oligodontia.

Anodontia↗
PubMed2005

The effect of rate of distraction osteogenesis on structure and function of anterior digastric muscle fibers.

The authors hypothesized that distraction at a rate of 3 mm/day, compared with mandibular distraction at a rate of 1 mm/day, would produce a maladaptive response in adjacent muscles of mastication. The authors further hypothesized that the maladaptive response would manifest at the single fiber level by means of increased sarcomeric heterogeneity, decreased maximum force output, and increased susceptibility to stretch-induced injury. In an ovine model, distraction osteogenesis of the right hemimandible was performed at either 1 mm/day for 21 days (n = 2) or 3 mm/day for 7 days (n = 2) to achieve a total distraction distance of 21 mm. The left hemimandibles served as controls. After a consolidation period of 2 days, the anterior digastric muscles were harvested; in six randomly selected single fibers from each muscle, maximum calcium-activated force (Po) was measured at optimal sarcomere length. The amount of damage to the sarcomeres in each fiber was assessed microscopically. To test susceptibility to contraction-induced injury, each fiber was given an activated stretch of 20 percent. Compared with control fibers and fibers distracted at 1 mm/day, maximum tetanic force (Po) was significantly lower in fibers distracted at 3 mm/day. Compared with control fibers, specific Po (Po/cross-sectional area) was lower in fibers distracted at 3 mm/day. The number of sarcomeres appearing damaged in fibers distracted at 3 mm/day was significantly higher than in control fibers or in fibers distracted at 1 mm/day. A greater deficit in Po was observed after a single activated stretch in fibers distracted at 3 mm/day than in control fibers or in fibers distracted at 1 mm/day. The authors conclude that distraction of the anterior digastric muscle in sheep at 3 mm/day produces a maladaptive response in the muscle fibers but a rate of 1 mm/day is tolerated by the muscle fibers. These data are consistent with the hypothesis that distraction of skeletal muscle at high rates results in increased heterogeneity of sarcomere lengths and that this increase in heterogeneity is the most likely potential mechanism resulting in whole muscle force deficits and in increased susceptibility to stretch-induced injury in distracted muscles.

Animals↗
PubMed2001

A new device for microincremental automatic distraction osteogenesis.

We have invented a distraction device that can be placed intraorally and provides autodistraction. The device consists of two units: an implantable component that is applied directly on the bone, and an external component that is distant from the surgical site. The external component is mounted on a standard, battery-driven portable syringe driver or infusion pump. A fine flexible non-compressible tube connects the two. The compression of the bellows in the external component causes fluid to be forced through the connecting tube into the distraction component. The combination of the sealed system and incompressible fluid guarantees expansion of the bellows of the distraction component and gradually separates the bone segments.

Electric Power Supplies↗
PubMed2000

[Distraction osteogenesis of the mandible in craniofacial abnormalities].

In recent years, lengthening the human mandible by distraction osteogenesis has become an accepted treatment to correct severe mandibular hypoplasia. Using intraoral unidirectional and extraoral bidirectional distraction devices we report about our experiences and results in the application of the bone distraction technique in four selected cases of syndromal disease, including various forms of mandibular hypoplastic malformations. The patients involved were a boy with Pierre Robin syndrome, a girl with unilateral facial hypoplasia in Goldenhar's syndrome, a case with Nager's syndrome, and a rare case of midline deficiency caused by partial deletion of chromosome 18 (18p-syndrome). The distraction period lasted from 6 to 30 days and new bone formation, ranging from 6 to 28 mm, was achieved.

Adolescent↗
PubMed2002

Biomechanical properties of regenerated bone by mandibular distraction osteogenesis.

OBJECTIVE: To study the biomechanical properties of the new bone generated by mandibular distraction osteogenesis (DO). METHODS: A total of 11 healthy adult goats were randomly divided into 2 groups, the experimental group (n=9) and the control group (n=2). For the goats in the experimental group, the bilateral mandibles were gradually lengthened for 10 mm with distraction appliances. Three goats were sacrificed respectively at 2, 4 and 8 weeks after completion of distraction. Compressive, three-point bending and shearing tests were conducted on the standard regenerated bone samples and the whole unilateral mandibular specimens. For the goats in the cont rol group, no operation was made and the whole unilateral mandible was taken as the test specimen. RESULTS: The compressive strength and bending stiffness of the new bone reached the normal level at 4 and 8 weeks after completion of distraction, respectively. But the shearing strength remained significantly weaker than that of the controls at 8 weeks after distraction. CONCLUSIONS: The distraction appliance can be removed and the lengthened mandible should be exposed to adaptive functional exercise at 8 weeks after completion of distraction.

Animals↗
PubMed1999

Combined maxillary and mandibular distraction osteogenesis.

Mandibular elongation by gradual distraction in patients with hemifacial microsomia is a simple and effective procedure to correct facial asymmetry. The changes in mandibular dimension result in changes in dental occlusion. These are minimal in children because of the rapid growth of the maxilla and can be corrected easily with minor orthodontic treatment. Mandibular distraction in adults with hemifacial microsomia produces good aesthetic results but leaves the patient with a severe alteration in the occlusion requiring complex orthodontic treatment over a long period of time. To avoid this problem, an incomplete Le Fort I osteotomy is performed simultaneously with the mandibular corticotomy. Intermaxillary fixation is placed on the fifth postoperative day, and distraction is initiated. This technique preserves the preexisting stable occlusion. After distraction, both the maxillary and mandibular occlusal planes become horizontal, and facial asymmetry is corrected.

Adolescent↗
PubMed2002

The effects of magnitude and frequency of distraction forces on tissue regeneration in distraction osteogenesis of the mandible.

Callus distraction has become an accepted treatment procedure to lengthen hypoplastic mandibles in humans. For this purpose, extraoral and intraoral devices have been applied successfully. The effects of the distraction vector, distractor stability, and rate and frequency of callus distraction on the regenerating tissues have been examined in various studies. In an experimental animal trial on pigs (n = 12), a newly developed microhydraulic osteodistractor was tested. The animals were evenly assigned to two groups to perform a continuous and noncontinuous osteodistraction of the mandible. Initially, the forces necessary to distract the pig mandibles were recorded from a noncontinuous distraction procedure; the results were then used to perform continuous bone distraction. Besides testing the new distractor, the study proved that in continuous osteodistraction, intramembranous bone regeneration occurred, whereas in noncontinuous osteodistraction the bone regeneration process followed a chondroid ossification. In continuous osteodistraction, the bone regeneration proceeded at a higher speed with the lower distraction forces compared with noncontinuous distraction, thereby reducing the consolidation period. Clinical and microscopical results are presented.

Animals↗
PubMedDate not supplied

Neuromuscular recovery after distraction osteogenesis at different frequencies in a rabbit model.

The muscle and nerve responses to stresses applied during distraction osteogenesis have not been clearly defined. This study hypothesized that distraction resulting in 30% lengthening decreases muscle force generation of the lengthened muscle and increasing the frequency of distraction attenuates the decrease of force generation accompanying lengthening. This study investigated the effects of different distraction frequencies on neuromuscular recovery in a rabbit model. Animals were assigned into group 1 (low-frequency distraction) and group 2 (high-frequency distraction). Distraction was continued until a 30% increase in the original tibial length was achieved. After consolidation of the osteotomy, knee and ankle range of motion, muscle force generation, and neuromuscular junction parameters were evaluated. Lengthening of 30% resulted in significantly decreased range of motion compared with the control leg (P < 0.05). Lengthening of 30% also substantially decreased force generation of the peroneus longus muscle. However, force generation of the peroneus longus muscle in the high-frequency group was 70.5% +/- 6.5% of the control side, significantly higher than that in the low-frequency distraction group (49.7% +/- 4.8% of the control side, P < 0.05). There was no statistical difference between the 2 groups in neuromuscular junction morphology, although an abnormal shape of the postsynaptic neuromuscular junction was observed after distraction. The use of a high-frequency distraction technique during limb lengthening may result in a reduction in impairment of knee and ankle range of motion and improved muscle function compared with that observed with the use of low-frequency distraction. Repeated microtrauma to the soft tissues associated with high-frequency distraction may facilitate the regenerative capacity of the soft tissues and result in an improved outcome of muscle and nerve function.

Animals↗
PubMed2005

Mandibular elongation by automatic distraction osteogenesis: the first application in humans.

We report the case of a 65-year-old man who was the first person to have the right ramus of his mandible lengthened by 20mm by automatic continuous distraction osteogenesis. The device consists of two units: a component that is implanted into the bone, and an external component that is distant from the surgical site and mounted on a battery-driven portable syringe driver or infusion pump. A non-compressible drive cable connects the two.

Aged↗
PubMed2003

Effects of osteogenic protein-1 on distraction osteogenesis in rabbits.

In this study we tested the effect of locally applied osteogenic protein 1 (OP-1) on distraction osteogenesis in rabbits. Seven days after tibial osteotomy, distraction was started at a rate of 0.25 mm per 12 h for 3 weeks. At the end of the distraction period, OP-1 was injected at the site of osteotomy. Four different dosages were tested (0, 80, 800, or 2000 microg; eight rabbits per dose group). Rabbits were sacrificed 3 weeks later, and histologic, densitometric, and biomechanical parameters were assessed. No significant differences were found between groups for any parameter. To explain why this approach was only modestly successful, the expression of BMP receptor protein in the newly formed tissue was analyzed by immunohistochemistry. Strong expression of BMP receptor IA, IB, and II was found during the early distraction phase, but not during later stages of the process. Thus, it appears that the lack of receptor protein in the target tissue impairs the effect of OP-1 given at the end of the distraction period. Possibly, OP-1 could be more useful when applied early in the distraction phase.

Animals↗
PubMed2006

Effects of parathyroid hormone on newly regenerated bone during distraction osteogenesis in a rabbit tibial lengthening model. A pilot study.

OBJECTIVE: The overall purpose of the study is to determine the effects of parathyroid hormone (PTH) (1-34) on bone formation in regenerated and surrounding bone of distracted callus during limb lengthening in rabbits. Additionally the aim of the pilot study is to titrate the optimal dose of PTH for distraction osteogenesis treatment in rabbits' tibial lengthening model. MATERIALS AND METHODS: A total of 18 rabbits underwent right tibia lengthening by callus distraction. Lengthening was started 5 days postoperatively 1 mm/day for a 10-day period and consolidation of 20 days followed. Rabbits were divided into three groups: group I received PTH (1-34) treatment at a dose of 5 microg/kg/day, group II received treatment with PTH (1-34) at a dose of 25 microg/kg/day; group III rabbits were treated with saline. After euthanasia, tibiae of both legs were dissected free, kept frozen and underwent x-ray analysis, dual x-ray absorptiometry-scanning, microcomputed tomography scanning and three-dimensional evaluation and mechanical test followed. RESULTS: Over all, during distraction osteogenesis in a new regenerated bone, PTH (1-34) treatment with two different doses of 5 microg/kg/day and 25 microg/kg/day increased callus cross-sectional area, callus bone mineral density and bone mineral content, bone volume density; dramatically increased trabecular number with slight increase in trabecular thickness, whereas decreased trabecular separation, bone surface density and decreased degree of anisotropy when compared to control group animals. CONCLUSION: PTH (1-34) treatment improved mineralization, structural indices of regenerated distracted rabbits' tibiae, whereas treatment at a dose of 25 microg/kg/day PTH (1-34) was significantly more effective than 5 microg/kg/day PTH(1-34) dose treatment when compared to control group. Bigger dose has been chosen for the main study.

Absorptiometry, Photon↗