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PubMed2000

Split free flap and monofixator distraction osteogenesis for leg reconstruction.

The use of a split muscle flap widens the indications of unilateral external fixation in the treatment of type IIIB open tibial fractures with large bone defects. The same frame can be used for early stabilization and for secondary distraction lengthening procedures. The use of a split flap allows an easy, safe, and painless pin migration. The combination of these techniques represents a very safe solution, especially for patients in poor general and vascular condition.

Bone Transplantation↗
PubMed2006

Genioplasty distraction osteogenesis and hyoid advancement for correction of upper airway obstruction in patients with Treacher Collins and Nager syndromes.

BACKGROUND: Treacher Collins and Nager syndromes may present with mandibular hypoplasia that causes posterior collapse of the tongue base and a decreased oropharyngeal airway. Mandibular distraction and orthognathic advancement are effective treatments to correct the airway, but failure may occur despite achieving class I occlusion. For this select population, the authors propose a novel procedure of genioplasty distraction and hyoid advancement to optimize epiglottal positioning. METHODS: Patients diagnosed with Treacher Collins (n = 5) or Nager syndrome (n = 3) with obstructive sleep apnea or tracheostomy dependency (n = 8) underwent genioplasty distraction and hyoid advancement. Airway outcome was assessed by preoperative and 1-year follow-up comparison of (1) laryngobronchoscopy, (2) sleep studies, and (3) tracheostomy dependency. For genioplasty outcome, three groups were used: group I (distraction genioplasty, syndromic) (n = 8), group II (acute genioplasty, syndromic) (n = 7), and group III (acute genioplasty, nonsyndromic) (n = 10). Lateral cephalogram measurements were used in the preoperative, postoperative, and follow-up periods to assess horizontal and vertical advancement and relapse. RESULTS: Epiglottal position was optimized by the procedure in all patients based on direct endoscopic assessment. All five patients with obstructive sleep apnea had resolution of symptoms, and two of three patients achieved removal of their tracheostomy. Mean advancement for groups I, II, and III was 25, 14, and 8 mm, respectively. Follow-up horizontal advancement for groups I, II, and III were 18, 4, and 6 mm, respectively. Cephalometric measurements showed a horizontal relapse for groups I, II, and III of 10, 62, and 11 percent, respectively. CONCLUSIONS: Data suggest that genioplasty distraction allows for a greater advancement and decreased relapse rate than acute procedures alone; and genioplasty distraction with hyoid advancement is a useful technique for resolution of obstructive sleep apnea or to achieve tracheostomy removal in those syndromic patients who have already undergone mandibular advancement into a class I occlusion.

Adolescent↗
PubMed2004

Secondary intramedullary nailing after distraction osteogenesis: 30 patients followed for 2-12 years.

BACKGROUND: There is no consensus about replacement of an external fixator by reamed intramedullary nailing in fracture cases. PATIENTS AND METHODS: We evaluated the outcome in 30 patients (33 segments) of secondary intramedullary nailing during the consolidation phase after callus distraction using an external device. The main reasons for nailing were docking site nonunion (17 patients), angular deformity or fracture of the lengthened area (8 patients) or intolerance of the external device (5 patients), in 11 patients combined with a delayed distracted callus maturation. The average follow-up time was 4 (2-12) years. RESULTS: Intramedullary infection after nailing occurred in 1 case, and slight loss in callus length in 5 cases. Failure of union at the docking site with nail breakage occurred in 1 case. In the other patients, consolidation in the lengthened callus area and also union at the docking site were achieved on average 6 months after nailing. INTERPRETATION: We believe that intramedullary nailing during the consolidation phase after bone lengthening or bone transport is a treatment option for delayed callus maturation or docking site nonunion, reducing prolonged use of the external fixator.

Adolescent↗
PubMed2002

Differences in mandibular distraction osteogenesis after corticotomy and osteotomy.

Corticotomy or osteotomy was performed on opposing sides of the mandibles in 18 goats. A custom-made distractor was used to lengthen the mandible at a rate of 1 mm/day for 10 days (total 10 mm elongation). Six goats were sacrificed respectively at 2, 4 and 8 weeks after completion of distraction. The distracted calluses were harvested and processed for radiographic, histologic, and scanning electron microscopic evaluation as well as Ca/P ratio analysis. The regenerate bone in the corticotomy side showed more bone formation and earlier mineralization than in the osteotomy side. The results of this study suggest that preservation of intramedullary vessels is beneficial to bone regeneration following mandibular osteodistraction, and that performing corticotomy may be a simple but effective way to promote the maturity of the distracted callus and shorten the time for fixation.

Animals↗
PubMed2006

Mandibular distraction osteogenesis enhanced by bone marrow mesenchymal stem cells in rats.

OBJECTIVE: This study was to observe the effects of bone marrow mesenchymal stem cell transplantation on new bone formation in a rat mandibular osteodistraction model. MATERIAL AND METHODS: Autologous bone marrow stem cells were obtained from tibiae of 40 male rats. Two weeks after cell harvest, the rats underwent right mandibular distraction and were then randomly divided into two groups (group A=20, group B=20). After distraction was complete, the stem cells were injected into the distracted gaps in group A, while the rats in group B only received physiological saline. Twenty rats (10 from each group) were sacrificed on postoperative days 27 and 55, respectively. The distracted mandibles were harvested and processed for radiographic, histological and histomorphometric analysis. RESULTS: The radiodensity of the distraction zone was higher in group A than in group B at both time points. Histologically callus was found in both groups but more bone was formed in group A. Histomorphometric analysis also demonstrated that both new bone volume and thickness of the new trabeculae were significantly greater in group A than in group B. CONCLUSION: The results of this study suggest that autologous bone marrow stem cell transplantation may be considered as a potential method to accelerate bone regeneration in the distraction gap, and enhance consolidation.

Animals↗
PubMed2001

Preprosthetic vertical distraction osteogenesis of the mandible using an L-shaped osteotomy and titanium membranes for guided bone regeneration.

PURPOSE: Vertical osteodistraction is a new alternative method for alveolar ridge augmentation of the mandible. The purpose of this article is describe a technique using an L-shaped osteotomy and titanium membranes for guided bone regeneration (GBR) in the distraction gap. PATIENTS AND METHODS: Ten patients with severe atrophy of the edentulous molar region of the mandible underwent vertical callus distraction in 13 sites using intraoral microplate distractors. An L-shaped osteotomy with a short vertical part mesially and a longer horizontal part ending in the retromolar region was made, and the osteotomized segment was fixed to the mandibular ramus at its distal edge by a microplate, which became the center of rotation when distraction began. In this way, more callus generation could be achieved mesially than in the distal molar region. Follow-up computed tomography (CT) scans reconstructed axially to the axis of the mandible revealed semilunar excavations of the generated bone buccally in the distraction gap in the first cases. Clinical inspection on removal of the distractors showed fibrous connective tissue in the gap. Therefore, to prevent this from happening, titanium membranes covering the distraction gap were applied in subsequent cases. RESULTS: Ten patients (13 sites) were treated by vertical callus distraction. In 4 cases, GBR was achieved using titanium membranes. In all cases, the increase in alveolar height was sufficient to make dental implantation possible. In 1 patient, a fracture of the distractor occurred, and dehiscence was observed in 2 cases. These complications did not change the plan of therapy nor did they influence the results. The CT scans showed a homogenous surface on the regenerated mandible in the cases of GBR application. CONCLUSION: Both an L-shaped osteotomy and the application of titanium membranes for GBR in the distraction gap are of great value for mandibular augmentation, producing a physiologically shaped alveolar ridge.

Adult↗
PubMed1999

The effect of magnitude and frequency of interfragmentary strain on the tissue response to distraction osteogenesis.

PURPOSE: Bone regeneration is believed to be partially controlled by the applied local mechanical strain. To test whether the magnitude or frequency of discontinuous traction regulates the tissue response, defined daily strains were applied on mandibular osteotomies using an implanted mechanical distractor. MATERIALS AND METHODS: Unilateral mandibular osteotomies were performed in skeletally immature rabbits (n = 36). and distraction was done by applying 2,000, 20,000, 200,000, or 300,000 microstrains once or 10 times (2,000, 20,000 microstrains) per day, respectively. Sham-operated animals (n = 6), serving as controls, underwent frame application and osteotomy without distraction. At the end of the distraction process, the newly formed tissue was evaluated histomorphometrically by the use of a well-defined scoring system of bone-forming indices. RESULTS: The highest bone-forming indices were detected in the osteotomized, nondistracted group and in samples exposed to a physiologic strain (2,000 microstrains). Application of hyperphysiologic strains (200,000 and 300,000 microstrains) resulted in the formation of fibrous tissue and decreased bone-forming indices. Using Kruskal-Wallis tests, a statistically significant relationship was found between the bone-forming indices and the applied strain magnitudes. Scanning and transmission electron microscopic examinations showed osteoblastic differentiation and early mineral deposition in samples distracted up to 20,000 microstrains, whereas higher strain magnitudes led to the formation of fibroblast-like cells surrounded by collagen fibrils and only slight mineralization. Multiple strain applications (10 cycles/d vs 1 cycle/d) did not alter the histomorphometric indices or ultrastructural morphology significantly but increased the amount of newly formed tissue. CONCLUSIONS: These results suggest that the magnitude and not the frequency of mechanical loading controls the differentiation of bone cells and the subsequent formation of bone tissue.

Analysis of Variance↗
PubMed1999

Alveolar ridge augmentation by distraction osteogenesis using titanium implants: an experimental study.

The left mandibular premolars were extracted from five adult dogs. After twelve weeks, a box-shaped osteotomy of the alveolar bone was carried out and two 10 mm implants were placed 5 mm into the transport alveolar segment, leaving 5 mm exposed. The alveolar bone was vertically augmented 5 mm by screwing the implants. After distraction, the implants were left to integrate into the bone. Histological and radiographical evaluations showed the lifting of the transport segment and the development of new bone in the distraction area. Although integration of implants within both the transport segment and the regenerated bone was observed, two of the ten implants failed and partial bone resorption of the transport segment was noted.

Alveolar Process↗
PubMed2005

[Vertical distraction osteogenesis of the alveolar process for implant treatment].

The rehabilitation of the chewing function of a patient is ultimately dependent on the quality and volume of the available jawbone. The vertical augmentation of the jawbone is often a challenge for the implanting dentist. Various methods, from transplanting autogenous bone through to the employment of bone substitute materials have been described and often controversially discussed. Vertical distraction offers an alternative to the pre-implantological augmentation of the vertically reduced bone. A technique which shows certain advantages over conventional augmentative methods.

Adolescent↗
PubMed2002

Distraction osteogenesis: a treatment tool to improve baseline conditions for esthetic restorations on immediately placed dental implants--a case report.

Replacement of two adjacent teeth in an anterior maxilla with deficient hard and soft tissues appears to be the utmost challenge in implant dentistry in the esthetic zone. In this case report, baseline conditions for implant placement were improved by alveolar distraction to enhance hard and soft tissues around the maxillary central incisors. Three months after the active phase of distraction, the roots of the central incisors were extracted and two screw-type dental implants were immediately placed into the extraction sockets. For immediate provisionalization, acrylic resin crowns were fabricated on UCLA abutments, providing the ideal emergence profile to support the periimplant soft tissue. Six months after implant placement, the prosthetic restoration of the case was finished with ceramic crowns cemented to individually fabricated zirconium oxide abutments. The described treatment strategy appears to have a great potential to restore natural esthetics in cases with major tissue deficiencies in the esthetic zone.

Acrylic Resins↗
PubMed2006

Vertical distraction osteogenesis of fibular bone flap in reconstructed mandible.

Excellent functional and aesthetic results can be achieved in mandibular reconstructions with using free fibular bone flap. However, the vertical deficiency between the reconstructed segment and the occlusal plane made dental rehabilitation impossible in some cases. We encountered this problem in our 3 patients who had mandibular reconstruction with fibular flap due to extensive bone defect result from gunshot injury. To overcome this segmental vertical distraction of the reconstructed mandible was performed. Fibular bone segments (40-70 mm) were distracted with using extraoral distraction device after a latency period of 5-7 days. The rate of distraction was 1 mm/day, and the rhythm was 4 times (4 x 0.25 mm). Distraction was continued until the desired height was achieved, and the distractor left in place for 12 weeks for bony consolidation. No minor or major complications were encountered. The increase of vertical height was between 9 and 13 mm, and it was stable during the follow-up period (7-22 months). Following the vertical distraction and vestibuloplasty operations, the dental restoration of the patients was performed with mandibular removable partial dentures.

Adult↗
PubMed2001

[Vertical augmentation of the alveolar process by distraction osteogenesis].

This article describes the treatment of a boy with Class II deep bite and hypoplasia of the alveolar process due to agenesis of the canines and premolars. At first, the occlusion has been adjusted by advancement of the mandible and opening of the bite after bilateral sagittal split osteotomy. Later, under local anaesthesia, a segmental osteotomy of the hypoplastic alveolar process has been performed. Distraction of the hypoplastic alveolar process has been achieved by orthodontic traction on the residual dentition in the segments. After sufficient augmentation of the alveolar process, 6 implants for two bridges have been placed.

Adolescent↗
PubMed2005

Mandibular distraction osteogenesis in Pierre Robin sequence: application of a new internal single-stage resorbable device.

Pierre Robin sequence may result in physiologically significant obstructive apnea in the neonatal and infant period. This may be life threatening and is most often treated by tracheostomy. To avoid tracheostomy or allow for early decannulation in severely affected infants and children, the authors have developed a new class of neonatal and infant mandibular bone distraction devices. These devices require a single operative procedure for placement and no operative removal is necessary. Fifteen infants (aged 7 days to 11 months; mean age, 3 months) and five children (aged 2 to 8 years; mean age, 5.5 years), 10 boys and 10 girls, with severe obstructive apnea and Pierre Robin sequence were treated with the mandibular infant devices over a 24-month period. Tracheostomy was avoided in 14 patients, whereas five of six patients who had previous tracheostomy were decannulated after mandibular distraction. The final tracheostomy status in one patient will be determined after surgery for gastroesophageal reflux. There were no major complications and no structural device failures.

Abnormalities, Multiple↗
PubMed2000

Effect of electrical stimulation on mandibular distraction osteogenesis.

This study was designed to examine whether the use of electrical stimulation during mandibular lengthening accelerates new bone formation. Twenty adult female rabbits weighing between 2800 g and 3200 g underwent left mandibular body osteotomy. After a 3 day latency period, an external fixation device was activated at a rate of 0.7 mm per day for 10 days. Direct current electrical stimulation of 10 microA was applied to 10 rabbit mandibles. Two of the screws were used as electrodes during the distraction phase. The other 10 rabbits (control group) were not stimulated. The device was then stabilized for periods of 10, 20, 30 and 60 days in both groups. The distraction segment was evaluated radiographically by assessing the proportion of bone mineral density using a dichroma scan. The amount of new bone formation was studied histologically with an image analyzer to evaluate the bone formation in the distraction gap. Histological examination showed that the new bone formation 10 and 20 days after distraction was greater in the electrical stimulation group than in the control group. Ten and 20 days after distraction, image analysis and analysis of bone mineral density in areas of newly formed bone indicated that there was a greater amount of new bone formation in the stimulation group than in the control group. The radiographic evaluation, however, did not demonstrate significantly different images between the stimulation group and the control group. Thirty and 60 days after distraction, no difference in the amount of new bone formation was noted in either the experimental or the control groups. These results indicate that electrical stimulation during gradual distraction promotes new bone formation in the early retention period in a rabbit model.

Absorptiometry, Photon↗
PubMed2001

[Costal chondral grafting combined with mandibular distraction osteogenesis. A new approach to the correction of the temporomandibular joint ankylosis in an adult. A report of a case].

The authors present a thirty two years old women complaining of a temporomandibular joint ankylosis. History revealed a mandibular trauma sustained during the early infancy. The patient presented a typical bird face deformity with a maximal mouth opening of zero millimiter. Facing the squelettal deformation, the authors decide to combine a simultaneous costochondral graft with bilateral horizontal branch distraction. Good functional and aesthetic results allow the patient to return to a good social integration with no sign of recurrence at the medium term follow-up.

Adult↗
PubMed2006

Multiplanar distraction osteogenesis of fibula free flaps used for secondary reconstruction of traumatic maxillary defects.

Traumatic maxillary bone loss, if not treated acutely, is accompanied by contracture of the overlying soft tissue envelope and loss of facial projection in three dimensions. Reconstruction aimed at replacing the bony architecture, expanding the soft tissue envelope and establishing a platform for dental rehabilitation can be accomplished in a staged approach. We present two patients who underwent replacement of missing maxillary segments with a free fibula flap, followed by distraction of the free fibula in three dimensions and eventual dental rehabilitation with osseo-integrated implants.

Adult↗
PubMed2004

A paralleling device and ethylene vinyl acetate baffles for use with mandibular distraction osteogenesis: technical note.

A novel method for planning the placement of intra-oral lengthening devices using a paralleling device is described and illustrated with a case report. Simple radiographic measurements and study models are all that is required to construct a simple acrylic splint with guides, which allows accurate positioning of the distractors at surgery. The construction of ethylene vinyl acetate (EVA) baffles to prevent trauma to the labial mucosa from the intra-oral link arms is a technique that enhances patient comfort during distraction of the mandible. The case report demonstrates the application of the surgical planning technique and the use of EVA baffles for a patient with an overjet of 21.5 mm.

Acrylic Resins↗
PubMed1997

Treatment of tibial and femoral bone loss by distraction osteogenesis. Experience in 28 infected and 14 clean cases.

42 patients with diaphyseal bone defects (25 tibial and 17 femoral) who were treated by radical debridement and bone transport are reviewed. Their mean age was 35 (10-64) years and there were 29 men. 19 patients had active infections with drainage and 9 were previously infected. After resection of the infected and necrotic bone, the intercalate defect averaged 6 (3-12) cm. The mean duration of treatment was 10 (20-52) months. Regeneration of the distraction gap was achieved in all 42 patients. Union at the target zone was achieved in 38, and in the remaining 4 cases consolidation was achieved by application of autogenous bone grafts. The infection was eradicated in all 28 patients treated for bone defects associated with infection, without the need for a second operation. Complications were not severe and did not affect the final results. Residual malalignment remained in 2 patients, 1 femur and 1 tibia, with 10 degrees and 8 degrees of varus deformity, respectively. The final leg-length discrepancy never exceeded 1.5 cm. Residual fixed flexion of the knee was left in 5 cases, but never exceeded 10 degrees. Loss of 5 degrees to 10 degrees of dorsiflexion of the ankle joint remained in 7 patients. There were no intraoperative or postoperative neurovascular damage or compartment syndrome. Psychological intolerance was seen in 1 young patient. All patients, but 3 returned to their previous occupation. Bone transport is a simple and safe method for successful treatment of diaphyseal bone defects.

Adolescent↗