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PubMed2002

Distraction osteogenesis for reconstruction after mandibular segmental resection.

Distraction osteogenesis with the shortening and lengthening method is a well-established procedure for repairing extremities. We used this technique for reconstruction after mandibular segmental resection. A 74-year-old woman underwent distraction osteogenesis with an intraoral device, initially shortening the mandible after a 20-mm-long segmental resection, followed by lengthening at a rate of 0.8 mm per day for 21 days. Eight weeks after the distraction, the device was removed and a dental implant was placed at the site of distraction. Radiographic observation showed new bone formation, and the implant was completely osseointegrated. Although the follow-up period is relatively short, the clinical course was uneventful. Distraction osteogenesis with the shortening and lengthening method seems to be a feasible option for reconstruction after segmental resection of the mandible.

Aged↗
PubMed2000

Two-year follow-up of distraction osteogenesis: its effect on mandibular ramus height in hemifacial microsomia.

Distraction osteogenesis has been used to lengthen the mandible in patients with hemifacial microsomia. Questions regarding soft tissue and skeletal growth after distraction osteogenesis have not been clearly elucidated in the literature. In this case report, a 2-year follow-up of distraction osteogenesis in a 7 year old boy is documented with lateral and posterior/anterior cephalometric analysis. The analysis was performed preoperatively and at specific postsurgical periods to evaluate the facial soft tissue and skeletal growth patterns. Objective analysis of this growing patient after distraction osteogenesis clearly demonstrates that the anteroposterior elongation of the mandible is relatively stable, whereas the vertical lengthening and soft tissue effects are minimal. Critical evaluation of other patients who have undergone distraction osteogenesis is needed to determine if this was an isolated incident or the expected result in similar patients.

Abnormalities, Multiple↗
PubMed2004

[The treatment of comminuted midfoot fractures with distraction osteogenesis].

OBJECTIVES: We evaluated the results of distraction osteogenesis with the Ilizarov circular external fixator in the treatment of comminuted fractures of the midfoot. METHODS: Four patients (1 female, 3 males) with comminuted midfoot fractures due to high energy trauma were treated with distraction osteogenesis performed by the Ilizarov circular external fixator. The mean age was 24 years (range 19 to 37 years). Fractures resulted from a traffic accident in one case, and from vehicle blast due to landmine explosion in three cases. The circular external fixator was applied for a mean of three months (range 2.5 to 4 months), during which the mean distraction was 10.5 mm (range 9 to 13 mm) at the fracture zone. The results were assessed according to the presence of pain and limping, radiographic measurements, and to the AOFAS (the American Orthopaedic Foot and Ankle Society) scoring system. The mean follow-up period was 58 months (range 33 to 81 months). RESULTS: All the patients had limping for a month following the removal of the fixator. At the end of six months, limping disappeared in one patient, decreased in two patients, and remained as a sequela in one patient. Pain which occurred during walking after the removal of the fixator decreased and finally disappeared within 3 to 6 months in three patients, but remained in one patient. Radiographic assessments were made using the anteroposterior and lateral X-rays of the foot. The mean AOFAS score was 70.5 (range 50 to 89). CONCLUSION: Distraction osteogenesis performed with the use of the Ilizarov circular external fixator may be an alternative in the treatment of comminuted foot fractures due to high energy traumas, where no other modality is likely to provide an anatomical reduction.

Adult↗
PubMed2004

Unexpected events during mandibular distraction osteogenesis.

Various unexpected events during mandibular distraction osteogenesis are described in 16 syndromic children with severely retrognathic or asymmetric lower jaws who were treated with unilateral or bilateral extraoral distraction. The mean total time with the distraction devices attached was 14 weeks (range 10-19). Although improvement in facial aesthetics and the desired occlusion was achieved in all but one case, there were unexpected events associated with mandibular distraction. These included pain not related to the operation, functional disturbance in movement of the jaw, dietary problems, weight loss, unfulfilled expectations of decannulation, temporary unilateral facial nerve palsy, and transient unilateral hypoaesthesia of the inferior alveolar nerve. Reoperation was required in 5 of the 16. In addition to these events, psychosocial problems within one family complicated the procedure. Patients and their families should be informed of the lesser-known aspects of distraction osteogenesis before the procedure is used.

Adolescent↗
PubMed1999

Strain-related bone remodeling in distraction osteogenesis of the mandible.

Distraction osteogenesis has become a mainstay in craniofacial surgery. However, there are several unresolved problems concerning the biology of bone regeneration. We investigated the biomechanical effects of mandibular lengthening in 32 rabbits on a cellular and histologic level. The mandible was subjected to a corticotomy, held in a neutral position for 4 days, and then lengthened at various strain rates and frequencies for 10 days. Radiographic, histologic, and electron microscopic examinations showed a strain-related bone regeneration. Application of physiologic strain rates (2000 microstrains or 0.2 percent) led to a bridging of the artificial fracture exhibiting woven ossification, whereas at 20,000 microstrains trabecular bone formation was demonstrated. In contrast, hyperphysiologic strain magnitudes (200,000 microstrains and 300,000 microstrains) showed a fibrous tissue formation. Multiple strain applications (10 cycles/day versus 1 cycle/day) increased the width of the distraction gap without changing the stage of bone regeneration. The gradual distraction of bone in physiologic magnitudes at higher frequencies seems to be desirable for a bony differentiation and may help to improve clinical applications.

Animals↗
PubMed2002

Immunohistochemical study of osteopontin expression during distraction osteogenesis in the rat.

Distraction osteogenesis (DO) is a limb-lengthening procedure that combines mechanical tension stress with fracture healing to provide a unique opportunity for detailed histological examination of bone formation. Osteopontin (OPN) is a multifunctional matricellular protein believed to play a key role in wound healing and cellular response to mechanical stress. We studied the expression of OPN during DO using standard immunohistochemical (IHC) staining techniques. In addition, we compared the expression of OPN to proliferation (PCNA-positive cells) in the DO gap. After 14 days of distraction in the rat, these stains revealed variations in OPN expression and its relationship to proliferation according to the cell type, tissue type, and mode of ossification examined. Fibroblast-like cells within the central fibrous area exhibited intermittent low levels of OPN, but no relationship was observed between OPN and proliferation. In areas of transchondral ossification, OPN expression was very high in the morphologically intermediate oval cells. During intramembranous ossification, osteoblasts appeared to exhibit a bimodal expression of OPN. Specifically, proliferating pre-osteoblasts expressed osteopontin, but OPN was not detected in the post-proliferative pre-osteoblasts/osteoblasts that border the new bone columns. Finally, intracellular OPN was detected in virtually all of the mature osteoblasts/osteocytes within the new bone columns, while detection of OPN in the matrix of the developing bone columns may increase with the maturity of the new bone. These results imply that the expression of OPN during DO may be more similar to that seen during embryogenesis than would be expected from other studies. Furthermore, the biphasic expression of OPN during intramembranous ossification may exemplify the protein's multi-functional role. Early expression may facilitate pre-osteoblastic proliferation and migration, while the latter downregulation may be necessary for hydroxyapatite crystal formation.

Animals↗
PubMed1990

Segmental mandibular regeneration by distraction osteogenesis. An experimental study.

We report the use of distraction osteogenesis for segmental mandibular regeneration. This technique has been used in thousands of patients in the Soviet Union to regenerate as much as 30 cm of tubular bone in the extremities. However, we are unaware of previous experimental or clinical reports of segmental mandibular regeneration by distraction osteogenesis. In a canine model, 2.5-cm segmental mandibular defects were filled with regenerate bone in 25 days at a rate of 1.0 mm/d using bifocal distraction osteogenesis. The diameters of the regenerate segments were comparable with preexisting mandible, and all animals resumed normal oromandibular function following regeneration. The regenerate bone was evaluated radiographically, angiographically, and histologically. In the control group without distraction osteogenesis, the segmental defects failed to fill with regenerate bone. The theoretical basis for distraction osteogenesis, a detailed description of the technique, and a review of previous studies on experimental mandibular lengthening are presented.

Animals↗
PubMed2003

Distraction osteogenesis for treatment of bone loss in the lower extremity.

Distraction osteogenesis has been widely utilized to treat leg length discrepancy, deformity, nonunion, osteomyelitis, and bone loss. It has been found that most difficult conditions can be resolved with this method. This paper introduces the usefulness of distraction osteogenesis for the treatment of nonunion and bone loss after tumor excision. The procedure was found to be extremely effective for the treatment of nonunion accompanied by bone loss and infected nonunion. In particular, the Ilizarov method offers a simultaneous solution for several problems related to nonunion, such as instability, infection, deformity, bone loss, joint contracture, limb length discrepancy, and skin defects. In addition, distraction osteogenesis is safe, useful, and efficient for the treatment of bone loss even after tumor excision. Joint preservation and reconstruction by means of distraction osteogenesis is the most conservative limb-saving surgery available at present. Furthermore, distraction osteogenesis can provide natural limb regeneration.

Bone Nails↗
PubMed2004

Biomechanical and clinical implications of distraction osteogenesis in craniofacial surgery.

INTRODUCTION: Craniofacial distraction osteogenesis is an established surgical procedure to correct bony malformations. Force transduction through the osteotomized bone fragments elicits defined biological responses in the gap tissue, which determines the clinical success of the distraction treatment. OBJECTIVE: The purpose of this investigation was to evaluate clinically a new distraction protocol based on an analysis of the biological and biomechanical parameters executing direct effects on bone regeneration during distraction. STUDY DESIGN: A multistep distraction protocol was used in 39 patients and the clinical outcome was monitored postoperatively. RESULTS: All the distraction cases were successful with a single exception. Segmental displacements were stable clinically and radiologically. CONCLUSION: In order to improve the clinical success of distraction osteogenesis, individual treatment protocols are recommended.

Adolescent↗
PubMed2004

Continuous mandibular distraction osteogenesis using superelastic shape memory alloy (SMA).

Distraction osteogenesis is a well-established method of endogenous tissue engineering. It is a biological process of bone neo-formation between segments subjected to tension. The concept of this study was to investigate the distraction osteogenesis with a device capable of creating a permanent and constant force during the whole process as if a very large number of small elongations were applied constantly. The mechanical testing of the device used to produce the constant force and the in vivo analysis of the bone growth after it was implanted in rabbits are presented on this work. The device consists of a NiTi coil spring, superelastic at body temperature, in order to have a stress plateau during the austenitic retransformation during the unloading. The in vivo analysis was made on six female rabbits of 12 months old. A segmental mandibulectomy at the horizontal arm of the mandible and a corticotomy at 5mm distant from the gap were made. Next, following a latency period of five days, the SMA springs were implanted to induce the bone neo-formation. The displacement at the unloading plateau shows that it is necessary to have longer springs or to use several (available commercially) in series in order to fulfil the requirements of a human distraction. The temperature variations induced changes in the spring force. However, when the temperature returns to 37 degrees C the distraction force recovers near the initial level and does so completely when the distraction process continues. For the in vivo study, all six rabbits successfully completed the distraction. The radiographies showed the gap as distraction advanced. A continuity in the newly formed bone with similar transversal and horizontal dimensions than the original bone can be observed on the histologies. In conclusion, the application of a constant force on distraction osteogenesis, using SMA springs, may be a successful alternative to the conventional gradual distraction.

Animals↗
PubMed1994

Basement membrane of blood vessels during distraction osteogenesis.

A canine model of distraction osteogenesis has recently been developed that permitted the evaluation of bone formation and its vascularization during bifocal callotasis. In this model, the authors examined the composition of the blood vessels during distraction osteogenesis of the mandible for laminin and for Type IV collagen, both constituents of the vascular basement membrane. At the fibrous distraction site, at the juncture of the free cortical surface and the regenerated bone, and at the abutting cortical surfaces at the distal margin of the defect, laminin and Type IV collagen were present in all vessels.

Animals↗
PubMed2003

Use of distraction osteogenesis in cleft palate patients.

Distraction osteogenesis (DO) has been used recently to correct maxillary hypoplasia with predictable and stable results. In patients with clefts of the secondary palate, DO can also be used to aid in vertical alveolus augmentation and rapid orthodontic tooth movement. If an osteotomized dental arch can be transported to a new position without complications, it would reduce or eliminate the need for a secondary bone graft to the cleft alveolus in cleft patients and help prevent dentoalveolar defects by approximating the native alveolar bone and gingiva. Mobilizing a segment in the dentoalveolar region also results in the creation of new bone and attached gingiva. This report shows that the application of DO for skeletal expansion and rapid movement of tooth-bone segments should receive more careful consideration in the treatment of patients with clefts of the palate.

Adult↗
PubMed2000

The application of distraction osteogenesis to the maxillofacial skeleton.

Distraction osteogenesis is a new concept of treatment initiated from orthopaedic surgery and is gaining rapid acceptance by oral and maxillofacial surgeons as a treatment for severe craniofacial syndromes. This paper reviews the application of this new technique to the cranio-maxillofacial area and presents our experience from the use of intra-oral distractors in China.

Adolescent↗
PubMed1998

Distraction osteogenesis in craniofacial surgery: a review.

Distraction osteogenesis is a technique of new bone formation by the gradual separation of bony fragments. The method, although initially developed for limb lengthening, is now being applied in the treatment of craniofacial deformities. A number of principles have been established through careful scientific study to guide clinical practice, such as the ideal rate and rhythm of distraction, the need for periosteal preservation during bone division, a "latent period" of neutral fixation before, and a "consolidation period" after distraction. The technique is being applied in craniofacial surgery particularly for mandibular deformities and offers considerable advantages over previous methods such as osteotomy and inlay bone grafting. Donor site morbidity is avoided, the investing soft tissue envelope is concurrently expanded, and the magnitude of the procedure is less. However, the technique is still in its infancy and requires further modification and refinement before widespread acceptance as a treatment in mainstream craniofacial surgery. Problems with cutaneous scarring and socially undesirable external hardware, particularly in the pediatric population, have led to the emergence of intraoral miniature devices, with the ultimate goal of development of a multiplanar internal autodistractor. Furthermore, many principles well established in leg lengthening, such as the rate and rhythm of distraction, need to be reexamined and the parameters redefined with particular reference to the craniofacial skeleton. Distraction osteogenesis has an expanding role in craniofacial surgery.

Animals↗
PubMed2002

Ultrasound can predict regenerate stiffness in distraction osteogenesis.

Assessing the regenerate strength in distraction osteogenesis is crucial for clinical treatment. Several methods have been used to achieve this, including plain radiography, digital radiography, quantitative computed tomography, dual energy xray absorptiometry, and ultrasound. The aim of the current study was to investigate the use of ultrasound in monitoring regenerate formation and to correlate this to biomechanical testing results. An osteotomy was done on the tibia of 30 Yucatan micropigs and an Ilizarov-type half-ring external fixator was mounted. After a 5-day latency period, the tibias were distracted for 10 days and then left to consolidate for 10 days. Seven ultrasound examinations were done during Day 15 through Day 25. After sacrifice, the bone mineral density was measured using quantitative computed tomography. Maximum load and torsional stiffness were measured and correlated with ultrasound measurements and bone mineral density. The ultrasound penetration depth and the bone mineral density correlated closely with torsional stiffness. Ultrasound can be a noninvasive predictor of bone regenerate strength in the early phase of distraction osteogenesis, which may reduce the need for radiographs.

Animals↗
PubMed2006

Temporomandibular joint bony ankylosis: comparison of treatment with transport distraction osteogenesis or the matthews device arthroplasty.

Temporomandibular joint (TMJ) bony ankylosis with micrognathia is a rare congenital condition that is difficult to treat and may result in recurrence. In a series of affected patients, we compared two new methods of treatment: transport distraction osteogenesis and Matthews Device arthroplasty. All patients had computed tomography scan documented bilateral TMJ bony ankylosis. Group I (transport distraction osteogenesis) underwent distraction advancement of the mandible (for micrognathia) followed by resection of the condyles, recontouring of the glenoid fossas with interposition temporoparietal-fascial flaps, and transport distraction osteogenesis of mandibular rami segments. Group II (Matthews Device arthroplasty) underwent all of the above procedures except for transport distraction osteogenesis. Instead, the Matthews Devices were anchored to the temporal bone and mandibular rami. Hinged arms allowed for motion at the reconstructed TMJ. In both groups, patients underwent extensive postoperative therapy. Preoperative, postoperative, and follow-up lateral cephalograms were obtained, and incisor opening distances were recorded. All patients but one had severe micrognathia (n = 9). For group I (transport distraction osteogenesis), mean age was 6.8 years. and mean advancement was 28.5 mm. For group II (Matthews Device arthroplasty) mean age was 8.2 years, and mean advancement was 23.5 mm. In group I (transport distraction osteogenesis), mean incisor opening was 1 mm preoperatively and 27.5 mm postoperatively; however, it relapsed to 14.3 mm by 12.5 months follow-up (48% relapse). Mean incisor opening in group II (Matthews Device arthroplasty) was 3.9 mm preoperatively and 33.4 mm postoperatively and remained at 30.6 mm after 11.1 months follow-up (8% relapse). One patient in group I (transport distraction osteogenesis) underwent surgical revision because of relapse. Our data showed that for congenital TMJ bony ankylosis both transport distraction osteogenesis and Matthews Device arthroplasty techniques were successful initially; however, the Matthews Device arthroplasty avoided long-term relapse.

Adolescent↗
PubMed2003

Three-dimensional surgical planning for maxillary and midface distraction osteogenesis.

Computerized surgical planning protocols for distraction osteogenesis are still in their rudimentary phase. The authors have developed a system to plan distraction osteogenesis in craniofacial and maxillofacial surgery that uses three-dimensional computed tomography scans and computer simulation in a virtual reality environment. This involves the creation of a three-dimensional bone model of the craniofacial skeleton, which incorporates virtual globes. Virtual osteotomies are performed on the bone model and the movements of the bone segments are simulated. The program generates a recipe for the linear and the angular changes necessary to achieve the desired outcome. The purpose of this article is to present this surgical planning process and discuss its use in maxillary and midface distraction.

Child↗
PubMed2006

[Development of a novel in-vitro culture device simulating distraction osteogenesis and expression of osteoblast cytoskeleton].

OBJECTIVE: To establish a novel in-vitro culture device simulating distraction osteogenesis, and to understand the the changes of cytoskeleton of osteoblasts under different magnitudes of mechanical distraction. METHODS: A novel in-vitro culture device simulating distraction osteogenesis was developed with titanium and silicon membrane. The expressions of F-actin cytoskeleton subjected to different magnitudes of distraction were observed in situ under a confocal laser scanning microscope, and protein levels of actin and tubulin alpha were analyzed by electrophoresis of Western blot. RESULTS: The mode of culture device simulating distraction osteogenesis was similar to that of distraction osteogenesis used in clinic. After 24 h mechanical distraction with physiological magnitude, F-actin of osteoblasts was organized and paralleled to the direction of distraction forces. After 24 h mechanical distraction with hyperphysiological magnitude, however, F-actin of osteoblasts became reorganized and disrupted, and protein levels of actin and tubulin alpha decreased. CONCLUSIONS: The novel in vitro culture device simulating distraction osteogenesis is suitable for the study of distraction osteogenesis in vitro. Physiological mechanical distraction causes organization and rearrangement of actin cytoskeleton. However, hyperphysiological mechanical distraction results in reorganization and disruption of actin cytoskeleton.

Actins↗