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PubMed2006

Trans-sinusal maxillary distraction for correction of midfacial hypoplasia: long-term clinical results.

Maxillary distraction osteogenesis is indicated in severe angle class III malocclusions, and severe maxillary hypoplasia among some cleft patients and other craniofacial deformities. Twenty patients, aged 8-48 years (mean 17.8+/-10.5 SD) with maxillary and midfacial hypoplasia were treated. The follow-up period was 13-65 months (mean 35+/-16.3 SD). A trans-sinusal maxillary distractor was placed intraorally at each side of the maxilla. The distraction vector was predicted using specialist software, and was transferred to the patients using stereolithographic models and individual templates. A (high) Le Fort I type osteotomy was performed. The amount of activation varied from 8 to 17.5 mm (mean 13.1+/-2.9 SD). Soft and hard tissue formation resulted in complete healing across the distraction gaps. The distractors are almost completely submerged, and can be left in place as long as necessary to avoid relapse. Wit's appraisal was used to measure the stability of the long-term distraction results. Results up to 5 years after distraction showed considerable maxillary advancement with long-term stability. Ongoing growth of the facial skeleton must be considered when distraction osteogenesis is chosen in growing patients.

Adolescent↗
PubMed2002

LeFort III internal distraction in syndromic craniosynostosis.

Distraction osteogenesis of the mid-face alleviates the requirements of substantial autogenous bone grafts and donor site morbidity and alleviates the restriction of the soft-tissue envelope in gaining advancement of the mid-face. A prospective study, over a 14-month period, was initiated to evaluate the results of seven consecutive patients undergoing mid-facial advancement who were treated with Le Fort III internal distraction using the MID device. All patients had syndromic craniosynostoses and six patients had previously undergone fronto-orbital advancement. Four patients had symptoms of airway obstruction and one patient was tracheostomy dependent. Six of the patients completed the distraction as planned. Lateral cephalograms were analyzed and the mean linear distraction was 18 mm with a range of 8 mm to 23 mm. Complications included infection (one patient), mechanical failure (one patient), intraoperative fragment dysjunction (three patients), velopharyngeal insufficiency (one patient), conjunctivitis (two patients), trismus (six patients), and bony irregularities. It was concluded that in our Unit's future protocol for managing infant syndromic synostoses, synostectomies and cranial vault remodeling will be undertaken in infants as before, but that in early childhood, patients with severe mid-facial hypoplasia and/or respiratory compromise will be offered distraction osteogenesis as a substitute for the traditional Le Fort III advancement and bone grafting.

Adolescent↗
PubMed2001

[Mid-face distraction after LeFort III osteotomy in craniofacial dysmorphism].

BACKGROUND: The success of LeFort III-osteotomy with concurrent advancement of the midface in cases of severe, midfacial hypoplasia is limited by the soft covering tissue of the facial skeleton. There appear to be significant advantages in using distraction osteogenesis of the midface after surgery. CASE REPORT: We discuss the use of an extraoral distraction device after the osteotomy of a 10-year-old girl with Crouzon's disease. and the use of an internal device for a 6-year-old boy with severe midface hypoplasia following Apert's syndrome. RESULTS: In both patients a significant improvement of function, as well as harmonisation of the facial proportions, could be observed and the preoperatively planned distances of midface advancement of 18 and 15 mm respectively could be achieved. DISCUSSION: Distraction osteogenesis is an established procedure for the treatment of mandibular hypoplasia but few reports dealing with complex midface distraction are available outside of the specialist English language literature. We report on both external and internal distraction techniques with which good functional and aesthetic results were achieved.

Acrocephalosyndactylia↗
PubMed2000

Use of an islanded fasciocutaneous flap in the lower limb following distraction callotasis.

Severe limb injuries present a challenge to the attending surgeon and there has been an emergence of complex modes of treatment. The Ilizarov technique for distraction osteogenesis is accepted as a worthwhile option in selected cases of massive segmental bone loss. The blood supply of the bone during this process has been studied experimentally but the response of the soft tissue envelope to the process of compression followed by slow and progressive elongation is not entirely understood. We present a case of lower limb trauma where a combined approach to reconstruction was required with acute shortening followed by distraction osteogenesis for a major segmental tibial defect. Late soft tissue reconstruction for persistent ulceration over the tibia was then undertaken using a distally based fasciocutaneous flap.

Adolescent↗
PubMed2002

[Development of internal distractors for jaws: experimental and clinical studies].

OBJECTIVE: To introduce a series of internal distractors developed by the authors and results of experimental study and clinical trials. METHODS: Based on the demand of clinical use and experimental studies, 7 kinds and 17 types of internal distractors were developed. Required biomechanics were evaluated and animal studies were undertaken in 16 Rhesus monkeys and 12 goats with 40 distractors. Clinically, 68 Patients with 7 kinds of severe dento-gratho-facial deformities were treated with 82 distractors and the histocompatibility, stability, influence on new bone formation were evaluated. RESULTS: The 7 kinds of distractors were State-approved products made of Titanium alloy and permitted for use in human. The pull and twist force tests demonstrated that the loading capability of them were larger than 7.8 kgf and 5.0 kgf respectively. The domestic made Grade II screw was used to transmit the moving, it was nimble, without dead point, and with a forward-backward space of < 0.1 mm. The horizontal space in between the two fixing parts was < 0.1 mm. The parallel degree of the two direction-guide rods was within 0.05 mm. Animal and clinical studies demonstrated that there was no rejection response of the tissues. There were fractures of the direction-guide rods in two early cases, the design was improved then. Other results both experimentally and clinically were satisfactory with good osteogenesis. CONCLUSIONS: This series of domestic made internal distractors can be used satisfactorily in distraction osteogenesis for various kinds of jaw deformities. The successful production of these distractors will provide a good foundation to popularize the internal distraction osteogenesis of the jaws.

Animals↗
PubMed2005

Mandibular distraction with MD-DOS device.

Distraction osteogenesis is an alternative treatment method for the correction of mandibular hypoplasia. In this case report, mandibular distraction with a dynamic osteosynthesis system (MD-DOS) was performed to gradually lengthen the mandible of a patient who had a severe hypoplastic mandible. The patient underwent intraoral bilateral mandibular distraction osteogenesis. The latency period after the operation was seven days. The distraction was performed three times daily for 14 days at the rate of 0.33 mm each time. Subsequent retention was nine weeks. The patient's mandible was elongated successfully and a satisfactory profile and occlusion was achieved.

Adult↗
PubMed2002

[Transforming growth factor-beta superfamily in the regulation of new bone formation].

OBJECTIVE: To review the recent advances in transforming growth factor-beta(TGF-beta) superfamily study and its role in new bone formation. METHODS: The latest original articles related to this subject were retrieved extensively, especially the effect of TGF-beta, bone morphogenetic proteins(BMPs) and activin(ACT) on distraction osteogenesis. RESULTS: TGF-beta, BMPs and ACT play important roles in prompting new bone formation and each of them has different effects. Among them, TGF-beta can stimulate the proliferation of osteoblast and synthesis of extra cellular medium; BMPs can initiate the differentiation of interstitial cell to osteocyte; then ACT displays the combine effect of above two factors. CONCLUSION: TGF-beta superfamily can regulate new bone formation and thus shorten the course of mandibular distraction osteogenesis.

Activins↗
PubMedDate not supplied

Mandibular lengthening by intraoral distraction using osseointegrated implants.

Mandibular lengthening by distraction osteogenesis is a new method for use in treating congenital deformities or postsurgical bone defects. However, the use of extraoral transcutaneous pins in the mandible has disadvantages, such as facial scars and facial nerve or inferior alveolar nerve injury. The purpose of this study was to establish a new approach to distraction osteogenesis in the mandible by using osseointegrated implants and an intraoral device. Ten adult canines were used for this experiment. After extraction of the teeth and placement of two titanium implants in the left mandible, connection of the intraoral distraction device to the abutments, and corticotomy in the medial portion between implants were performed. Distraction was done at the rate of 1 mm per day to elongate 10 mm in length. Radiographic and histologic examinations showed that successful mandibular lengthening was achieved. New bone was primarily formed by intramembranous ossification and partial endochondral ossification. Titanium implants placed for anchorage of the device remained stable during the course of mandibular lengthening. Study results suggest that the intraoral device using osseointegrated dental implants can be used as a mechanism for distraction osteogenesis in the mandible.

Animals↗
PubMed2003

Current airway management in craniofacial anomalies.

PURPOSE OF REVIEW: Airway obstruction requiring intervention occurs frequently among children with craniofacial anomalies. The presence of a craniofacial anomaly is a common reason for tracheotomy in the pediatric population. Because of the complications associated with tracheotomy, however, numerous other methods have been proposed to alleviate severe airway obstruction in this patient population. RECENT FINDINGS: Nonsurgical management of airway obstruction remains the initial treatment option in children with craniofacial abnormalities; however, a significant number of patients fail to respond to this management strategy. Perhaps the most significant recent alternative airway management technique is the use of distraction osteogenesis to advance the mandible and maxilla. This technique has been used both to achieve early decannulation and to avoid a tracheotomy in infants and children with craniofacial anomalies. SUMMARY: Multiple options exist for relieving upper airway obstruction in craniofacial patients, and the application of these treatment strategies is dependent on the patient's disease and the philosophy of the treating institution. Future research into the management of airway obstruction in children with craniofacial anomalies will need to focus on predicting which children will benefit from conservative management and which children will need distraction osteogenesis or a tracheotomy.

Airway Obstruction↗
PubMed2005

Comparison of various types of stiffness as predictors of the load-bearing capacity of callus tissue.

The ability to predict load-bearing capacity during the consolidation phase in distraction osteogenesis by non-invasive means would represent a significant advance in the management of patients undergoing such treatment. Measurements of stiffness have been suggested as a promising tool for this purpose. Although the multidimensional characteristics of bone loading in compression, bending and torsion are apparent, most previous experiments have analysed only the relationship between maximum load-bearing capacity and a single type of stiffness. We have studied how compressive, bending and torsional stiffness are related to the torsional load-bearing capacity of healing callus using a common set of samples of bone regenerate from 26 sheep treated by tibial distraction osteogenesis. Our findings showed that measurements of torsional, bending and compressive stiffness were all suitable as predictors of the load-bearing capacity of healing callus. Measurements of torsional stiffness performed slightly better than those of compressive and bending stiffness.

Animals↗
PubMed2000

[Progressive bone elongation of the maxillo-facial area: mandibular distraction].

Thanks to the distraction osteogenesis technique, it is nowadays possible to create new bone in the facial area. Between january 1997 and march 1999 we have performed 20 such procedures, from which 15 were mandibular. We present our experience in 10 patients with this new technique, 5 unilateral and 5 bilateral. Those were 7 boys and 3 girls, aged 2 to 14 years, affected with hemifacial microsomia, Goldenhar syndrome: 3; retrognatism with severe malocclusion: 4; facial assimetry due temporomandibular joint abnormalities: 2; and facial assimetry: 1. The proposed elongation was achieved in all cases. There was not only a skeletal improvement, but also growth and remodeling of the facial soft tissues. Distraction osteogenesis is the early treatment of the mandibulofacial deformities and offers a great deal of advantages to the growing patient.

Adolescent↗
PubMed2006

An alternative method for the treatment of nonunion of the tibia with bone loss.

In this retrospective study we evaluated the method of acute shortening and distraction osteogenesis for the treatment of tibial nonunion with bone loss in 17 patients with a mean age of 36 years (10 to 58). The mean bone loss was 5.6 cm (3 to 10). In infected cases, we performed the treatment in two stages. The mean follow-up time was 43.5 months (24 to 96). The mean time in external fixation was 8.0 months (4 to 13) and the mean external fixator index was 1.4 months/cm (1.1 to 1.8). There was no recurrence of infection. The bone evaluation results were excellent in 16 patients and good in one, while functional results were excellent in 15 and good in two. The complication rate was 1.2 per patient. We conclude that acute shortening and distraction osteogenesis is a safe, reliable and successful method for the treatment of tibial nonunion with bone loss, with a shorter period of treatment and lower rate of complication.

Adolescent↗
PubMedDate not supplied

Bone regeneration: new findings and potential clinical applications.

Bone is a biologically privileged tissue in that it has the capacity to undergo regeneration as part of a repair process. Fracture healing is the most common and recognizable form of bone regeneration, but several other examples of bone regeneration have been observed in humans, suggesting that the ability to regulate bone regeneration as a therapeutic tool should be possible. Historically, efforts at limb lengthening have led to procedures for regenerating bone, such as the method of Ilizarov. This procedure, known as distraction osteogenesis, has applications in a variety of skeletal conditions, including the restoration of large skeletal defects, the transport of bone in cases of severe trauma with bone loss, and the correction of skeletal deformities. Fibrodysplasia ossificans progressiva is an example of how an abnormal metabolic condition can be viewed as evidence for the capacity of humans to regenerate large amounts of bone if the cellular and molecular signaling events are altered. Elucidation of the cellular and molecular basis for bone regeneration in humans - particularly the role of the human genome in relation to the expression of various growth factors and cytokines, such as the bone morphogenetic proteins - offers great potential for the treatment of orthopaedic conditions. Development of specific bone morphogenetic proteins as therapeutic substances to induce bone regeneration in patients is well under way. As methods for enhancing fracture healing, distraction osteogenesis, and other procedures are refined, the development of protein- and gene-based therapies for regulating bone formation should lead to a new era of orthopaedic practice.

Bone Morphogenetic Proteins↗
PubMed2004

[Tractive force measurement in bone transport--an in vivo investigation in humans].

Bone transport applying the principle of distraction osteogenesis makes it possible to reconstruct long bone defects caused by trauma or resection of bone tumors. The method employing a central cable, developed in Munich, is especially suitable for such applications. The main bone fragments are stabilized by an external fixateur, and bone transport is effected with a single central cable fixed to the tip of the segment, and driven by an external, programmable motor. In 15 patients the tractive forces during the entire bone transport were measured with a strain gauge incorporated within the cable. On the basis of the force profiles characteristics normal bone transport (forces between 150-250 N) can be distinguished from a critical transport (forces > 250 N) with the risk of premature consolidation. There is some evidence that at a very high level of force, just before premature consolidation a very effective form of bone transport with good bone neoformation can be achieved. Transport systems employing a central cable allow this special form of distraction osteogenesis, since there is continuous force monitoring, and there is the option of employing the traction force as a control factor in a loop.

Adolescent↗
PubMed2001

Microstructural investigations of strain-related collagen mineralization.

Distraction osteogenesis in rabbit mandibles after osteotomy can be used as an experimental model to study the microstructural features of mineralization of callus under defined mechanical loads. Our aim was to study the relation between the micromotions in the gap and the resulting features of mineralization of the matrix. We found that assembly of collagen and formation of crystals depended on the magnitude of the mechanical stress applied. At physiological bone strains (2000 microstrains), the callus had collagen type I in a mature bone-like extracellular arrangement, whereas at 20000 microstrains bundles were orientated predominantly towards the tension vector. Maximum loads (200000 microstrains) resulted in disorganized assembly of the collagen. Quantitative energy-dispersive analysis by X-rays confirmed that high strains were associated with substantially lower concentrations of calcium and phosphate. In contrast to bone-like apatitic formation of crystals at physiological strains, significantly fewer but larger crystals were detected by electron diffraction analysis in samples exposed to high strains. We suggest that mechanical stress regulates the assembly and mineralization of collagen during distraction osteogenesis.

Animals↗
PubMed2003

Localized ridge augmentation/preservation. A systematic review.

BACKGROUND: Osseointegrated implants have been documented as efficacious, however, their placement may be contraindicated in some patients due to insufficient bone volume. Techniques such as guided bone regeneration (GBR), immediate implantation, and distraction osteogenesis (DO) have been utilized as ridge enhancement therapies. RATIONALE: This systematic review evaluates dental implant survival rates in patients treated with ridge augmentation or preservation techniques. FOCUSED QUESTION: In patients requiring dental implant placement, what is the effect of localized ridge preservation versus implant placement without augmentation on implant survival and adverse effects? SEARCH PROTOCOL: MEDLINE and Cochrane Oral Health Group Specialized Trial Register were searched. Hand searches were performed on Clinical Oral Implants Research, International Journal of Oral and Maxillofacial Implants, International Journal of Periodontics and Restorative Dentistry, Journal of Clinical Periodontology, Journal of Periodontology, and Journal of Periodontal Research. All searches were performed for articles published through April 2002. SELECTION CRITERIA: Publications reporting survival rate of dental implants following ridge therapy were included in the analysis. Reports describing techniques were excluded. DATA COLLECTION AND ANALYSIS: Due to the absence of controlled studies, a meta-analysis was not performed. Descriptive statistics are used to report the data. MAIN RESULTS: 1. A total of 18 studies were included: 13 reporting on guided bone regeneration (GBR, 1,741 patients) and 5 on distraction osteogenesis (DO, 92 patients). 2. There is a high level of predictable implant survival in sites treated by GBR or DO. 3. These survival rates are similar to those of implants placed in native bone. REVIEWERS' INTERPRETATIONS: Survival rates were similar for both GBR and DO implants. These survival rates were similar to implants placed in native bone.

Alveolar Ridge Augmentation↗
PubMed2000

Palatal distraction in a canine cleft palate model.

The purpose of this study was to determine whether the canine hard palate can be lengthened by distraction osteogenesis in a cleft palate model using a mostly submucosal distractor. Five mongrel dogs were used. After raising mucoperiosteal flaps, a midline strip of bone was removed from the hard palate of each dog to simulate the bony defect seen in a cleft palate. A transverse osteotomy was then made to separate the posterior segment of the hard palate from the anterior segment. Posterior osteotomies were also made laterally parallel to the teeth so that the 2 posterior segments (one on either side of the bony cleft) were mobile. An intraoral distractor that was mostly submucosal was attached to the anterior hard palate and both segments of the mobilized posterior hard palate. Radiopaque bone markers were placed, and x-rays were obtained. After a 10-day latency period, the distractor was expanded 0.675 mm per day until it had been lengthened 10.125 mm. Distractors were left in place for an additional 8 weeks. After distractor removal, animals were observed for an additional 8 weeks before euthanization. Follow-up x-rays and histologic examinations were performed. New bone formation was found at the site of distraction in all dogs at the time of death. This new bone was seen on the follow-up x-rays and on histologic examination of the hard palates using both hematoxylin and eosin staining and Masson's trichrome stain. Distraction osteogenesis using a mostly submucosal device is an effective technique for lengthening the hard palate in a canine cleft palate model. The technique may eventually provide an alternative treatment for velopharyngeal incompetence in humans that is more precise and involves less morbidity than existing treatments.

Animals↗
PubMed1998

Rigid external distraction: its application in cleft maxillary deformities.

Patients with severe maxillary hypoplasia secondary to congenital facial clefting present numerous challenging problems for the reconstructive surgeon. Traditional surgical/orthodontic approaches for these patients often fall short of expectations, especially for achieving normal facial aesthetics and proportions. The purpose of this paper is to present our clinical experience and cephalometric results with the use of rigid external distraction for the treatment of patients with severe maxillary deficiency. Eighteen consecutive orofacial cleft patients with severe maxillary hypoplasia were treated with maxillary distraction osteogenesis. Criteria for patient selection included severe maxillary hypoplasia with negative overjet of 8 mm or greater, patients with normal mandibular morphology, and patients with full primary dentition or older. There were 10 unilateral cleft lip and palate patients, 6 bilateral cleft lip and palate patients, and 2 patients with severe congenital facial clefting. A maxillary splint was prepared for each patient, and all patients underwent a high Le Fort I maxillary osteotomy. All surgery was performed on either an outpatient or a 23-hour admission basis. No patient required blood transfusions or intermaxillary fixation. Two types of mechanical distraction were utilized in this series. In group 1 (n = 14), the patients underwent rigid external distraction with an external distraction device. In group 2 (n = 4), patients underwent face mask distraction with elastics. There was no surgical morbidity in any of the patients. For the patients in the rigid external distraction group, the mean effective horizontal advancement of the maxilla was 11.7 mm. All of these patients had correction of their negative overjet. For patients in the face mask distraction group, the results were disappointing. The mean effective advancement of the maxilla in this group was only 5.2 mm. In all face mask distraction patients, the initial maxillary hypoplasia was undercorrected. Maxillary distraction osteogenesis with rigid external distraction permits full correction of the midfacial deficiency, including both the skeletal and soft-tissue deficiencies. Rigid external distraction in patients with severe maxillary hypoplasia allows full correction of the deformity through treatment of the affected region only. It offers the distinct advantage of correcting these severe deformities through a minimal procedure. Rigid external distraction has dramatically improved our treatment results for patients with severe cleft maxillary hypoplasia.

Adolescent↗