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PubMed2002

Pinhole osteotomy in distraction osteogenesis - a technical note.

A new surgical approach for performing the mandibular osteotomy for distraction osteogenesis is described. In order to minimize trauma to bone caused by the osteotomy - and adjacent soft tissue - caused by excessive stretching - an additional transbuccal pinhole incision is made. The shaft of the saw blade is passed through this incision. This allows a precise cut of the mandibular ramus at the planned angle and easy guidance of the saw during the procedure. The method can be used both with extraoral or intraoral distraction devices in children and adults.

Adult↗

PubMed2002

Vertical distraction osteogenesis of fibula transplants for mandibular reconstruction--a preliminary study.

INTRODUCTION: When reconstructing the mandible after tumour resection with a fibular graft, the mandible is often vertically deficient, making placement of dental implants impossible. PATIENTS: Segmental vertical distraction of the reconstructed mandible was performed in nine patients following tumour surgery between February 1998 and 2001. Their age was 14-65 years (average 46.3); all underwent radiotherapy with a dose of up to 55.6 Gy prior to tumour resection. Mandibular discontinuity was repaired with a microvascular fibular bone graft. All grafts had a vertical bone deficit ranging from 9 to 12 mm when compared with the non-resected part of the mandibles. METHODS: All patients underwent segmental vertical distraction of the transplants. The distraction devices were applied intraorally. Distraction of 1.0 mm/day was performed using a Martin distractor (TRACK 1.5) followed by 12 weeks retention time. RESULTS: The increase of vertical bone height was stable and enabled placement of dental implants without any complications. CONCLUSION: Vertical distraction osteogenesis may become a common procedure in the treatment of alveolar ridge deficiency resulting from transplanting fibulae for mandibular reconstruction following tumour surgery.

Adolescent↗

PubMed2003

Three-dimensional cranial expansion using distraction osteogenesis for oxycephaly.

Oxycephaly is associated with raised intracranial pressure as a result of the fusion of multiple cranial sutures. We have performed an effective and less invasive cranial expansion by means of three-dimensional cranial distraction for the treatment of oxycephaly with suspicion of increased intracranial pressure. We describe two oxycephaly cases and the surgical technique of three-dimensional cranial expansion using distraction osteogenesis.

Absorbable Implants↗

PubMed2001

Mandibular distraction osteogenesis in very young patients to correct airway obstruction.

The purpose of this study was to measure changes in the airway cross-sectional area of pediatric patients with micrognathia and obstructive airway symptoms after treatment by mandibular distraction. The measurements obtained were correlated with the clinical outcomes.Ten patients, ranging in age from 3 months to 8 years, underwent measurement and distraction. Eight patients were under 30 months of age. Six were diagnosed with Pierre Robin sequence, two with Treacher Collins syndrome, and two with Nager syndrome. All patients had retrognathia of greater than 8 mm and obstructive airway symptoms while awake that had resulted in tracheostomy (3), repeated apnea monitor triggering (5), or abnormal sleep study (2). Cephalometric analysis was performed pretreatment and posttreatment by distraction. The effective airway space was defined with the following boundaries: a horizontal line from the tip of the odontoid to the velum, the uvula tip to the tongue base along the shortest line, the tongue base down to the base of the epiglottis, and the horizontal line to the posterior pharynx. These lines were traced for each cephalogram, the outline was digitized, and the area was calculated by computer. An analysis of the square area change was done by paired t test. The range of distraction was 8 to 22 mm; the mean effective airway increase was 67.5 percent, with a range of 26 to 120 percent. Measurable airway increase occurred in all patients who underwent distraction, and all patients showed clinical improvement. Six patients with Pierre Robin sequence became asymptomatic, with normal sleep, feeding, and weight gain. Two patients with Nager syndrome and tracheostomies were decannulated and were asymptomatic postdistraction. One patient with Treacher Collins syndrome without tracheostomy became asymptomatic after mandibular distraction; one patient failed to distract because of premature consolidation and continued to require a cannula. Mandibular distraction seems to provide a consistent change in tongue base position that improves obstructive airway symptoms by increasing measured effective airway space. The potential for mandibular distraction exceeds the simple correction of malocclusion also by eliminating soft-tissue obstruction of the micrognathic airway. Airway improvement is independent of the syndrome diagnosed. Mandibular distraction osteogenesis may be useful to avoid or decannulate existing tracheostomy in infants with micrognathia.

Airway Obstruction↗

PubMed2006

[Effects of mesenchymal stem cells transplantation on cranial suture distraction osteogenesis in growing goats].

OBJECTIVE: To observe the effects of mesenchymal stem cells (MSCs)on cranial suture under mechanical strain in growing goats. METHODS: 10 growing goats were used in this study. A customized distractor was used for distraction of the coronal suture at a rate of 0.4 mm/day for 8 days. The experimental group(5 goats) was injected with autologous MSCs into the distracted region, whereas the control group (5 goats) with injection of physiological saline. All animals were killed at 4 weeks after the end of distraction. Scanning electron microscopy and histological analysis were taken to observe the samples. RESULTS: 4 weeks after the end of distraction, the cranial sutures in all animals were separated successfully. The new bone formation at the edge of suture in the experimental group was superior to that in the control group. CONCLUSION: Autologous MSCs transplantation may promote the cranial suture distraction osteogenesis in the growing goats.

Animals↗

PubMed2002

The relationship between distraction length and treatment indices during distraction osteogenesis.

To evaluate the indices used to compare the results of limb lengthening with distraction osteogenesis, we analyzed the relationship between the lengthening and external fixation period in a series of 28 patients (30 limbs). The average lengthening was 4.6 cm (range, 2.0-8.9). The average age at operation was 16.6 years (range, 4-47). Limbs treated included 15 femurs and 15 tibias of 19 male and 9 female patients. The external fixation period and the maturation period had a direct linear relationship with length gain. There was a negative hyperbolic relationship between the external fixation index, maturation index, and length gain. Segments that were lengthened 0-3.0 cm had a maturation index of 38.3 days/cm and external fixation index of 57.6 days/cm, both of which were significantly higher than for those lengthened more than 3.0 cm. When comparing the maturation and external fixation indices between different patients or studies, the length of the distraction must be taken into consideration.

Adolescent↗

PubMed2000

Monobloc and midface distraction osteogenesis in pediatric patients with severe syndromal craniosynostosis.

We present 2 children with severe syndromal craniosynostosis who were in need of urgent midface advancement surgery due to recurrent ocular dislocations (Pfeiffer's syndrome type II) or severe upper respiratory obstruction (Crouzon's syndrome). They were operated using distraction osteogenesis, with gradual midface or monobloc advancements. In the Pfeiffer patient, a maxillary distraction of 25 mm achieved effective cessation of ocular dislocations, whereas a 23-mm monobloc advancement in the Crouzon patient achieved cessation of nocturnal arterial desaturations. No major postoperative complications were recorded. Distraction osteogenesis has become a versatile and safe technique that allows for large skeletal advancements.

Acrocephalosyndactylia↗

PubMed1997

Experimental study of distraction osteogenesis in the maxillofacial region.

A cylindrical incision was made in the calvarial bone of mongrel dogs. Using a distraction device that used bone-connecting implants as supports, vertical distraction osteogenesis of calvarial bone was performed. Calvarial bone was distracted vertically at a speed of 0.5 mm per day, making enlargement of the cranium possible. The gap that resulted from distraction was closed with newly formed bone. The implants made a solid connection with no oscillation or dislodgment from the external pressure used for distraction. Our results show that vertical distraction of thin calvarial bone can be done using osseointegrated implants as supports. This indicates the possibility of broadening the applications of this method to plastic correction of craniomaxillofacial bone.

Animals↗

PubMedDate not supplied

Distraction osteogenesis for cleft palate closure in a canine model.

OBJECTIVE: To assess the utility of distraction osteogenesis (DO) when applied to closure of a hard palate cleft in dogs. METHODS: A midline hard palate cleft was created in 10 mature dogs. Two were controls and had no distraction; the other 8 dogs underwent osteotomies with installation of customized DO devices to the hard palate. After a 10-day latency, distraction commenced at 1 mm/d. After a 14-day consolidation period, the device was removed and the mucosa closed. Each dog was injected with fluorochrome labels and serially killed at 2-week intervals. Bone healing was analyzed further with traditional histologic analysis and fluorochrome labeling. RESULTS: No serious complications occurred. Bone resorption and cleft widening occurred in both control dogs. Complete bone closure of the hard palate cleft was achieved with DO in 5 of 8 experimental dogs. Three experimental dogs had bone resorption and incomplete palatal closure. CONCLUSIONS: The application of DO techniques in closure of a hard palate cleft in a canine model is safe and well tolerated. Furthermore, in some cases, it proved effective in achieving bony closure of the cleft. Further investigation is warranted into innovative use of DO in treating children born with cleft palate.

Animals↗

PubMed1994

[Experiences with Ilizarov distraction osteogenesis with the AO spindle fixator].

For correction of leg length discrepancies and for the treatment of segmental bony defects we used a modular AO-fixator knowing that the principle of the distraction osteogenesis is not dependent of a special fixation device. In our small series the AO-fixator proved to be a good alternative to the ring fixator of Ilizarov for the use on the tibia but not on the femur where we noticed a relatively high incidence of complications, especially deformities of the axis. The distraction osteogenesis has proved to be an efficient technique for limb lengthening and segmental bone transport but is high demanding for the patient and the surgeon.

Adolescent↗

PubMedDate not supplied

Distraction osteogenesis using modified external fixation devices in five dogs.

Distraction osteogenesis was used to treat five dogs with limb deformities or limb shortening. The affected bones underwent osteotomy, and modified external fixators were attached. Complications included pin loosening, implant breakage, and soft-tissue contracture. Adequate limb length was attained in all cases, but clinical results varied from poor to excellent. Two dogs were not lame after the procedure, two dogs had improved function but were still lame, and one dog had complications necessitating amputation.

Animals↗

PubMed1989

The histology of distraction osteogenesis using different external fixators.

The local biology of distraction osteogenesis using Ilizarov and Wagner external fixators was compared in unilateral tibial lengthenings in two groups of eight dogs. Serial roentgenograms with histological correlation revealed some basic similarities as well as distinct differences between the two groups. All dogs fully bridged the experimental gap by intramembranous ossification. Subtle histological changes in the alignment of collagen bundles and subsequent ossification reflected the mechanical configuration of each fixator. The multiplanar, full-pin Ilizarov system delivered concentric load to the site of osteogenesis, inducing perfectly parallel columns of new bone. The uniplanar, one-half pin Wagner system induced angulation of the collagen and subsequent bone columns on the basis of eccentric load to the osteogenic interface. Despite a significant difference in axial rigidity, the Ilizarov and Wagner external fixators induced osteogenesis of equal volume.

Animals↗

PubMedDate not supplied

Mandibular distraction osteogenesis to relieve Pierre Robin airway obstruction.

Children with Pierre Robin sequence can present challenging airway management issues. We describe a neonate with a life-threatening airway obstruction secondary to severe micrognathia and glossoptosis. When the patient was 9 days old, bilateral distraction osteogenesis was performed to lengthen the mandible by 17 mm. The patient was subsequently extubated without further airway or swallowing difficulties.

Airway Obstruction↗

PubMed2002

Recombinant species-specific growth hormone increases hard callus formation in distraction osteogenesis.

The effect of growth hormone (GH) on secondary fracture healing and callus formation has been demonstrated in several previously investigated animal models. The aim of this study was to investigate and quantify the effects of GH on bone regenerates in a distraction osteogenesis model. In 20 mature female Yucatan micropigs, the tibia and fibula were osteotomized, stabilized with an external fixator, and distracted at 2 mm/day for 10 days after a 4 day latency period. The regenerates were allowed to consolidate for 10 days. Micropigs in the study group (ten animals) received a daily injection of 100 microg per kilogram body weight of recombinant porcine growth hormone (r-pGH). Micropigs in the control group (ten animals) received sodium chloride as placebo. After killing on day 25, a quantitative histomorphometrical analysis of the formed callus and the adjacent cortical bone was performed and the results of polychrome in vivo labeling were assessed. The regenerates of the r-pGH-treated animals showed a significantly larger callus area but no change in callus structure. We found islands of cartilage tissue in the regenerates of both groups; the calli from the control group exhibited a higher fraction of cartilage compared with the r-pGH group, but this was not significant. Quantification of the fluorescent in vivo labeling revealed that the distraction gap in GH-treated group showed significant ossification even during distraction. These results demonstrate that growth hormone can accelerate the maturation of the regenerate in distraction osteogenesis without changing the callus microstructure. This may prove to be a useful clinical tool for shortening the healing time in limb lengthening and bone segment transport.

Animals↗

PubMed2004

Distraction osteogenesis with conventional external fixator for tibial bone loss.

Between 1991 and 2002, we treated 21 patients with tibial bone loss using a conventional external fixator. Nine patients had an infected open fracture and 12 patients an infected nonunion. After corticotomy, the bone was distracted at the rate of 1 mm (1 mm/step) on alternate days or every 48 h. The mean follow-up period was 18.7 (6-108) months after fixator removal. The mean new bone gained was 7.4 (2-17) cm. The mean healing index was 44.7 (17-86) days/cm. Total wound infection was resolved in 19 limbs (90.5%), and 11/12 (91.6%) nonunions united. Union with acceptable alignment (< 7 degree of angulation) and limb-length difference (<2.5 cm) was achieved in 18 limbs (85.7%). The bone result was excellent in 17 tibiae, good in three, and poor in one. Eighteen limbs had an excellent and three a good functional result. This modified technique of distraction osteogenesis using AO/ASIF conventional external fixator is safe, cost effective, and a versatile tool in the management of tibial bone loss associated with infected nonunion and open fractures.

Adolescent↗

PubMed2005

Growth factor expression following clinical mandibular distraction osteogenesis in humans and its comparison with existing animal studies.

AIM: Lengthening the mandible by distraction osteogenesis (DO) is nowadays a well recognized technique in maxillofacial surgery. In this study growth factor expression profiles were examined in biopsies taken from six patients undergoing mandibular DO and compared with findings from a sheep model for mandibular DO. STUDY DESIGN: In all patients (and sheep), the ascending ramus was distracted 10-15 mm at a rate of 1mm/day using an intraoral device. Biopsies were taken from the centre of the distraction zone 21 days after completion of distraction. Using standard immunohistochemical techniques, samples were stained for platelet-derived growth factor (PDGF), transforming growth factor beta (TGF-beta), basic fibroblast growth factor (bFGF) and bone morphogenetic proteins-2, -4 and -7 (BMP-2, -4, -7), matrix metalloproteinases-1 and -3 (MMP-1, -3), the vascular endothelial growth factor (VEGF), a marker for endothelial cells (CD-31) and type IV collagen (Col IV). RESULTS: Positive staining for PDGF, bFGF, TGF-beta, BMP-2, -4, and -7 was noted in cells and matrix components. There was intense staining for MMP-1. Strong staining for CD-31 and COL IV was observed adjacent to vessels. VEGF staining was less specific. Similar findings were noted in the sheep model. CONCLUSION: Growth factor expression in the human distraction site is similar to that in the sheep model.

Adolescent↗

PubMed2003

Unilateral advancement of the maxillary minor segment by distraction osteogenesis in patients with repaired unilateral cleft lip and palate: report of two cases.

OBJECTIVE: Collapse of the maxillary minor segment with lateral crossbite is a common feature in patients with repaired unilateral cleft lip/palate because of maxillary alveolar bony defect and palatal scar tissue. Distraction osteogenesis (DOG) is an effective technique of lengthening and augmentation for bone and gingiva. This case report describes the effects of unilateral advancement of the maxillary minor segment by DOG in two patients with the repaired unilateral cleft lip/palate.

Adolescent↗

PubMed2002

Effect of maxillary distraction osteogenesis on velopharyngeal function: a pilot study.

OBJECTIVE: The purpose of this study was to examine preoperative and postoperative changes of velopharyngeal function in cleft patients who underwent maxillary distraction osteogenesis using the Rigid External Distraction System. STUDY DESIGN: Six cleft patients followed for a minimum of 12 months after maxillary distraction were examined. Plain and contrast lateral-cephalograms were obtained preoperatively and postoperatively, and speech evaluation was performed by the same authorized speech therapist at the same time points. RESULTS: The mean distraction amount at the anterior nasal spine was 11.7 mm (range, 7.4 mm - 15.0 mm). Both the nasopharyngeal depth and velar length increased after maxillary distraction, but the need ratio (nasopharyngeal depth/velar length) also increased after distraction. Although scores for velopharyngeal closure dropped a few points after maxillary distraction, the rating for hypernasality remained unchanged in all patients but the patient whose distraction amount was 15.0 mm. CONCLUSION: These results suggest that maxillary distraction of less than 15 mm may not markedly affect velopharyngeal function in cleft patients.

Cephalometry↗