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PubMed2005

Callus mineralization following distraction osteogenesis of the mandible monitored by scanning acoustic microscopy (SAM).

BACKGROUND: Scanning acoustic microscopy uses ultrasound to analyse histomorphology of tissues with microscopic resolution and delivers data about physical properties of the specimen. MATERIAL AND METHODS: Bony consolidation was monitored by scanning acoustic microscopy in 12 embedded specimens of dog mandibles after distraction osteogenesis. Increasing mineralization was detected by measurements of acoustic impedance (Z). RESULTS: There was a strong correlation between acoustic impedance and time of consolidation. Measurements of the speed of sound (v) provided specific information about non-mineralized zones of the distracted area. Distribution of density in the distracted area could be reconstructed by using the measurements of acoustic impedance and speed of sound. CONCLUSION: The method seems suitable for studying bone remodelling qualitatively and quantitatively.

Acoustics↗
PubMed2003

[Distraction osteogenesis in the midface. Indications, technique and first long-term results].

Since the beginning of 1998, eleven patients have been treated by osteodistraction to correct hypoplasia of the maxilla and midface of various origins. Among them were six patients who were treated by high LeFort I osteotomies and insertion of subcutaneous intraoral distraction devices in the malar region. In the remaining five patients extraoral distraction devices were applied after LeFort I, II and III osteotomies. Distraction osteogenesis was successful in all cases, resulting in a mean sagittal bone gain measured parallel to the skull base of 9.5 mm (range 4.5-12.0) in the group treated with intraoral distractors and a mean of 19.4 mm in the extraoral distraction group (range 15.0-25.0). All patients were kept under orthodontic supervision before, during, and after osteodistraction. In eight patients long-term cephalometric and clinical evaluation after a mean follow-up period of 24 months in the intraoral distraction group (range 22-26) and 12 months in the extraoral distraction group (range 10-14) show stable results concerning the skeletal and dental relations. Long-term follow-up is necessary.

Adolescent↗
PubMed2003

Rotation advancement of the midface by distraction osteogenesis.

A wide variety of disease processes produce alteration of midfacial skeletal growth, resulting in moderate-to-severe midface deficiency presenting as retrusion associated with Angle's class III malocclusion. Le Fort III osteotomies with advancement can provide an excellent tool for correction of this deformity. Recently, the corrective procedure of choice for advancement of midfacial segments has been distraction osteogenesis after osteotomy. Straight linear advancement is the most common choice for corrective movement of the midfacial segment, whether accomplished through acute surgical advancement or through the progressive distraction technique. Unfortunately, linear advancement can produce abnormal configurations, both at the nasal root and lateral orbits, regardless of the technique used. Enophthalmos, caused by orbital enlargement, may limit the advancement necessary to achieve class I occlusion. The authors have extended the utility of the Le Fort III procedure and have improved the final outcome by creating a controlled rotation advancement of the midfacial segment using distraction. The application of an existing internal distraction device is modified to control the movement of the midfacial segment in a rotation advancement path. Included in the series were 10 patients with severe midface retrusion secondary to multiple congenital syndromes, along with cleft lip and palate. The ages of the patients ranged from 6 to 14 years. An internal distraction system was used in all cases. Application of the distractor was substantially modified to simplify both fixation and removal and to produce controlled rotation advancement. The team orthodontist determined the final occlusal relationship. Percutaneous distractor drive rods were removed 4 to 6 weeks after active distraction to increase patient comfort. The distractors and all associated hardware were removed after 12 to 16 weeks of consolidation; follow-up periods ranged from 1 to 3 years. By using the modified distractor application to produce rotation advancement, the contour abnormalities at the nasal root and lateral orbit and the enophthalmos produced by linear advancement were eliminated. Significant improvement in facial contour and class I occlusion was obtained in all cases. Complications consisted of near exposure of the device in one patient. Stability has been excellent, with no relapse reported by the orthodontist. Rotational advancement of facial segments by distraction allows successful early intervention in patients with significant midface retrusion. The abnormal nasal root and lateral orbital configurations produced by direct linear advancement are avoided, and a stable and normalized facial configuration is produced.

Adolescent↗
PubMed1989

Distraction osteogenesis of a congenital amputation at the elbow.

A case is described demonstrating the effectiveness of distraction osteogenesis for the lengthening of a short below elbow congenital amputation. To our knowledge this technique has not been previously used in a patient with a congenital amputation. The surgical technique of corticotomy and postoperative lengthening is detailed. The result converted the level of patient performance from elbow disarticulation to functional below elbow status.

Bone Lengthening↗
PubMed2001

Segmental distraction osteogenesis of the anterior alveolar process.

PURPOSE: This article describes a nonextraction therapy for patients with anterior tooth crowding in the mandible or with an unfavorable relation between the anterior dentoalveolar area and the skeletal base. The method involves the gradual repositioning of the dentate segment by use of distraction osteogenesis. PATIENTS AND METHODS: The method was applied in 25 patients. Indications comprised skeletal Class II patients with crowding, Class I patients with crowding, and Class III patients requiring decompensation before orthognathic surgery. A special hinge-joint bone plate was developed to allow the rotation of the anterior bone segment into the desired position. The gradual repositioning was achieved with orthodontic appliances. RESULTS: The procedure was successful in all patients. The typical advancement at the incisal edge was 2 to 5 mm. CONCLUSION: This method represents a new approach for nonextraction therapy in the mandible. It requires no soft or hard tissue grafting and results in favorable tissue conditions at the distraction site.

Alveolar Process↗
PubMed2002

Vertical distraction osteogenesis of fibular free flap in mandibular prosthetic rehabilitation: a case report.

A 17-year-old boy underwent three cycles of chemotherapy and a subsequent mandibular resection for a Ewing's sarcoma of the left body and ramus. The mandible was immediately reconstructed with a microvascular osteomuscular fibular flap. One year after the mandibular reconstruction, distraction osteogenesis of the anterior portion of the fibula was performed using a Martin distractor according to the Hoffmeister technique. Bone lengthening was achieved at a rate of 1 mm/day by turning the device twice each day for 12 days. Subsequently, we waited for 70 days for bone consolidation to occur. After 6 additional weeks, five Maestro implants were placed into the distracted fibula. Bone specimens were retrieved with a trephine bur during implant placement. Mature bone was present after 70 days and after 6 months. The bone height increase was 12 mm.

Adolescent↗
PubMed2003

Simultaneous orbital expansion and intraoral distraction osteogenesis of upper and lower jaws in a patient with hemifacial microsomia.

BACKGROUND: Correction of a micro-orbit, caused by clinical anophthalmia is a very challenging task. In hemifacial microsomia a micro-orbit may be combined with hypoplasia of the malar and the ascending mandibular ramus. MATERIAL: A 5-year-old patient with hemifacial microsomia is described. Hypoplasia of the malar bone and the tilted occlusal plane were corrected by means of intraoral distraction osteogenesis in the upper jaw following precise simulation surgery on a 3D-model. At the same time, the ascending mandibular ramus was lengthened with a second distraction device and a spherical tissue expander was inserted into the hypoplastic orbit. RESULTS: The malar as well as upper and lower jaws were lengthened and positioned symmetrically. The orbital cavity was expanded to 79% of that of the healthy side. Following removal of the distraction devices, the expander was exchanged for a larger one and orbital expansion was continued until overcorrection of the orbit up to 118 percent was achieved. CONCLUSION: Orbital expansion is a minimally invasive method of enlarging the volume of the eye socket three-dimensionally. Intraorally activated buried distraction devices enable "growth" of the jaws making bone transplants avoidable in many cases. By combining both methods, complex malformations can be corrected simultaneously in children.

Child, Preschool↗
PubMed1998

The combination of endoscopy and distraction osteogenesis in the development of a canine midface advancement model.

The requirements for reconstruction in patients with midface hypoplasia can be formidable: a bicoronal scalp incision, Le Fort III or monobloc skeletal advancement, harvesting and insertion of bone grafts, application of rigid (and occasionally intermaxillary) fixation, blood transfusions, and prolonged operative time and hospitalization. The introduction of the endoscope offers the possibility of minimally invasive surgery with improved visualization of the osteotomy sites. The development of distraction osteogenesis as a surgical technique allows controlled and gradual advancement of the osteotomized skeletal segment and associated soft tissue. The purpose of this study was to develop a canine model of an endoscopically assisted Le Fort III osteotomy with attendant midface distraction. Four mongrels (20 kg in weight) were study subjects. Three 2-cm skin incisions were made (two perpendicular to the zygomaticomaxillary suture and one perpendicular to the nasofrontal suture). The soft tissue and periosteum were evaluated bluntly. Retractors specially designed for the project created a space for endoscopic visualization. Bilateral zygomatic, nasofrontal, and medial orbital wall osteotomies, corticotomies, or both were performed under endoscopic visualization using a reciprocating saw; the medial orbital wall sectioning was specifically not completed (i.e., corticotomy) to avoid laceration of the mucosa and attendant bleeding. The pterygomaxillary osteotomy was completed with an osteotome and mallet. Finally, the nasal septum was only partially divided with an osteotome to avoid excessive blood loss. Four distraction devices were placed across the above-noted osteotomies (two across the nasofrontal osteotomy and one across each lateral osteotomy). The animals were distracted 1 mm per day for 16 to 40 days after surgery (16-40 mm of linear distraction). Cephalograms and computed tomography scans were obtained before and after distraction. The animals were killed after remaining in fixation for 4 to 6 weeks after distraction. All soft tissue was removed and the skull was examined. Photos were obtained throughout the experiment for documentation. The study demonstrated that Le Fort III osteotomies can be performed successfully via small incisions with endoscopic assistance in canine subjects with excellent visualization and minimal bleeding. The advancement of the midface segment can be achieved by activation of an external distraction device.

Animals↗
PubMed2005

Comparison of two computer-assisted surgery techniques to guide a mandibular distraction osteogenesis procedure. Technical note.

The accuracy of distracted facial bone displacement depends on the preoperative clinical assessment, surgical planning and technique. The aim of this study was to evaluate two different techniques to guide the mandibular distraction surgical procedure using an intraoral device. This study was performed on a fresh cadavre. 3D reconstructions from a computed tomographic (CT) acquisition were used for the two techniques. The first technique comprised a customised stereolithographic template and the second technique used a computer-assisted surgery (CAS) unit to guide the osteotomy and the positioning and screwing of the distractor device. Both methods were planned and compared with the same 3D software. The authors discuss the feasibility and reliability of the two techniques. The accuracy of the two techniques appears to be comparable for clinical applications, although the rapid prototyping template technique appears to be more satisfactory.

Cadaver↗
PubMed1999

Optimal time for distraction osteogenesis in limbs with nerve repairs: experimental study in the rat.

The optimal period of time between peripheral-nerve repair and initiation of limb lengthening procedures has never been precisely determined. In the clinical setting, the surgeon must decide how long the repaired nerves should be allowed to heal before subjecting them to the forces created by the limb-lengthening process. The authors designed a study to quantify and qualify the effects of different recovery periods between initial nerve repair and subsequent limb-lengthening via distraction osteogenesis. Forty-two Sprague-Dawley male rats were randomized in two different categories of nerve repair: end-to-end and nerve grafts. At 4, 8 and 12 weeks after nerve reconstruction, the femur was submitted to limb-lengthening at a rate of 1 mm/day (0.25 mm every 6 hr). Sciatic Function Index (SFI) evaluation indicated that the impact of distraction was detrimental in the grafted nerves, although they maintained their electrical and morphologic properties at comparable levels to the non-distracted nerves. Nerves with direct coaptation presented an overall superior regeneration pattern. The findings in end-to-end repairs distracted at 8 weeks and those of grafted nerves at 12 weeks were comparable to those in distracted normal nerves. The morphology of the distracted nerves appeared to be more organized than that observed in the non-distracted nerves.

Animals↗
PubMed1994

Lengthening of the mandible by distraction osteogenesis: experimental work in rabbits.

The purpose of this experimental work was to lengthen the mandible in rabbits by means of distraction osteogenesis. The excellent results on the lengthening of the extremities with the Ilizarov technique and the unpredictable results in the mobilization of the facial bones by means of osteotomies and grafts are reasons for the application of the gradual distraction method in mandibular lengthening. Bone lengthening was first performed in 1905; but Ilizarov rekindled interest in 1951 when he induced bone neoformation in the extremities by the distraction technique using multiplanar wires and external circular fixators. We lengthened the mandible in 12 New Zealand adult rabbits using different mountings of the Ilizarov apparatus by means of two fixation techniques: transfixion and nontransfixion. In the transfixion group (6 rabbits), the two wires were passed through both mandibular rami. In this group, a 2-cm lengthening was obtained. In the nontransfixion group (6 rabbits), only one mandibular ramus was included with the transfixion wires. In this group, 1-cm lengthening was achieved. Unilateral lengthening was obtained with the nontransfixion technique and the lengthening of both rami with the transfixion technique. The results were evaluated by clinical periodic postoperative radiographs and histological studies of newly formed bone and surrounding soft tissues (masticatory muscles, arteries, and so on). The results demonstrated that lengthening of the mandible is obtained by means of a mature and normal new bone that is produced in the osteotomized area.

Animals↗
PubMed2002

Distraction osteogenesis in Pierre Robin sequence and related respiratory problems in children.

INTRODUCTION: Sleep apnea is one of the most frequent manifestations of respiratory obstruction. Historically this clinical entity has stimulated the production of numerous valuable contributions with one purpose in mind: the improvement of airway permeability. A multi-disciplinary approach is required to define the problem in anatomic and functional terms to avoid a tracheostomy and prevent long-term sequels. We decided on an approach that focuses on improving the projection of the tongue in the posterior pharynx; by lengthening the mandible and bringing the muscular insertions of the floor of the mouth forward, the antero-posterior dimensions of the airway are increased. OBJECTIVE: To evaluate mandibular distraction osteogenesis as a simple mandibular lengthening procedure useful as a definite treatment in patients with obstructive sleep apnea. MATERIAL AND METHODS: The series consisted of 15 consecutive patients, divided in four groups. Patients with acute upper airway obstruction who required endotracheal intubation, patients with no acute upper airway obstruction but with severe respiratory distress, patients with milder degrees of airway obstruction, and patients with long-term tracheostomies. Therapeutic interventions were performed according to the findings of each group. RESULTS: The patients were evaluated according to cephalometric analysis, polysomnograms, nasopharyngoscopy, and clinical data. Significant changes were seen in the cephalometric studies. There were no postoperative episodes of apnea; clinical improvement occurred in all patients and decannulation was possible in all patients. CONCLUSION: Mandibular distraction is a safe and reliable procedure for treating patients with obstructive sleep apnea.

Adolescent↗
PubMedDate not supplied

Treatment of adolescent Blount disease with the circular external fixation device and distraction osteogenesis.

The purpose of this study was to review both the anatomic and functional results of treatment of adolescent tibia vara with distraction osteogenesis by using the circular external-fixation device. Twelve tibias in eight patients were treated. Preoperative proximal tibial varus averaged 18 degrees (range, 7-26 degrees). Postoperatively the mean deviation from standard anatomic alignment of the proximal tibia was 2.5 degrees (range, 0-7 degrees). All patients were allowed to weight bear as tolerated throughout the 12 weeks of frame wear. Function was assessed by knee score and was improved in all patients at a mean follow-up of 23 months. There were no neurovascular complications or delayed unions. One patient required return to the operating room because of premature consolidation of his regenerate.

Adolescent↗
PubMed1995

Distraction osteogenesis for congenitally short lesser metatarsals.

Six lesser metatarsal lengthening procedures were performed in three patients using a miniature external fixator to perform distraction osteogenesis. The metatarsals were lengthened an average of 15.5 mm. The external fixator was left in place for an average of 15.5 weeks, with additional time in a cast or cast shoe. Complications included five occurrences of infection, two cases of premature healing of the osteotomy, one nondisplaced fracture through the new bone formation, and hypertrophic granulation at a pin site. While all metarasals were successfully lengthened, two rays (one patient) had symptomatic stiffness at the metatarsophalangeal joint with continued metatarsalgia.

Adolescent↗
PubMed1994

Distraction osteogenesis in the treatment of stiff hypertrophic nonunions using the Ilizarov apparatus.

The principle of treating stiff hypertrophic nonunions of long bones with distraction using the Ilizarov method permits simultaneous correction of axial deformity, angular deformity, translational deformity, shortening, and, in most instances, infection. Twenty-one hypertrophic nonunions in 19 patients were treated using the Ilizarov apparatus in distraction. Six of these patients had associated chronic osteomyelitis. Ilizarov treatment ranged from four to 12 months (mean, 6.5 months). Follow-up time ranged from three to 11 years. Stable union was achieved in all patients. Angular, axial, and translational deformities were corrected in all patients; length discrepancies were corrected in 18 of 21 patients (86%). Infection resolved in five of the six cases (83%) with chronic osteomyelitis. The sole complication was axial collapse of regenerate bone (in one patient with subsequent loss of 2 cm of lengthening) after premature removal of the Ilizarov fixator. Distraction osteogenesis in the treatment of stiff hypertrophic nonunions offers the most complete method of providing optimal limb function. The process allows the patient to maintain extremity mobility and weight bearing while undergoing treatment.

Adolescent↗
PubMed2005

[Study of the expression of integrin alphaV beta3 in mandibular distraction osteogenesis].

OBJECTIVE: To investigate the expression and distribution pattern of Integrin alphaV beta3 (ItgalphaV beta3) in course of distraction 44 adults New Zealand white osteogenesis and to quest for the function of ItgalphaV beta3 in distraction osteogenesis (DO). METHODS: rabbits were selected and divided randomly into 3 groups: DO, bone fracture and normal group. There were 20, 20 and 4 rabbits in each group separately. Animal models were established and animals were killed at different time points. Sections were stained by IHC method. Distribution and expression pattern of ItgalphaV beta3 were observed by semi-quantitative technique, and the results were managed with statistic methods. RESULTS: The expression of ItgalphaV beta3 was found both in the DO and bone fracture groups. The positive staining was seen mainly in vascular endothelial cells on cytomembrane and in cytoplasm. The staining intensity of group of DO was higher than that of the bone fracture group. CONCLUSION: ItgalphaV beta3 plays an important role in promoting the process of DO.

Animals↗
PubMed2001

Surgical and orthodontic considerations for distraction osteogenesis with ROD appliances.

Tooth-borne/hybrid distraction devices offer a new approach for intraoral DO and better control of the distracted bony segments. These appliances also offer a unique characteristic by using the teeth as reference points for obtaining parallelism of the distraction devices to each other and to the vector of distraction in bilateral cases. More studies may be needed for long-term evaluation of the obtained results with intraoral distraction devices as well as biomechanical analysis of stress distribution throughout the mandible after distraction.

Dental Stress Analysis↗
PubMed2006

Evaluation of delayed-image bone scintigraphy to assess bone formation after distraction osteogenesis in dogs.

OBJECTIVE: To quantitatively assess distraction-induced bone formation in a crural lengthening model in dogs by use of delayed-image bone scintigraphy. ANIMALS: 12 mature Labrador Retrievers. PROCEDURE: Dogs were randomly allocated to 1 of 3 groups. A circular external skeletal fixation system was mounted on the right crus of each dog. Osteotomy of the distal portion of the tibia and fibula was performed in groups 1 and 2 and was followed by a lengthening procedure of 10 mm in the first group only. The third group served as sham-operated controls. Delayed-image bone scintigraphy with technetium-99m hydroxy methylene diphosphonate was performed 2, 4, and 6 weeks after surgery. Delayed-image-to-region-of-interest, delayed-image-to-crural, and delayed-image-to-femoral scintigraphic activity ratios were calculated. New bone formation was quantified by use of densitometric image analysis, and values for the scintigraphic ratios were compared. RESULTS: In the distraction and osteotomy groups, delayed-image-to-region-of-interest and delayed-image-to-crural ratios increased significantly. Although densitometric image analysis revealed increased bone formation after distraction, the region-of-interest ratios and crural ratios were similar in both groups. All dogs had increased delayed-image-to-femoral ratios. CONCLUSIONS AND CLINICAL RELEVANCE: Delayed-image bone scintigraphy ratios were not effective at differentiating between the amounts of distraction-induced bone and osteotomy-induced bone. Metabolic bone activity in the adjacent femur was increased as a consequence of circular external skeletal fixator placement. Delayed-image bone scintigraphy was not adequately sensitive to quantitatively monitor bone formation but may be useful as an early predictor of bone healing.

Animals↗