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At least 1,459 records · Page 81Linked to original sources
PubMed2002

Segmental distraction of the midface in a patient with Crouzon syndrome.

We treated midface hypoplasia in a 20-year-old woman with Crouzon syndrome using a rigid external distraction device. The patient showed severe exophthalmos and maxillary retrusion, although relatively good occlusion had been achieved by long-term orthodontic procedures. We considered that our patient's particular condition could not be resolved by the usual Le Fort III osteotomy/midface distraction procedure, so we devised a segmental approach. The midface, mobilized by Le Fort III osteotomy, was divided into two segments by Le Fort I osteotomy; each fragment was connected to the rigid external distraction device to be distracted separately. Distraction was begun after 1 day at 1 mm/day. The upper and lower segments were distracted over 17 and 12 days, respectively. The patient's occlusion was fully corrected, and her facial contour was significantly improved. After 3 weeks of consolidation, we removed the distraction device. The clinical course was without complication, and no relapse was observed on the cephalogram or computed tomography scan obtained 1 year after the procedure. Our modified technique was helpful in increasing the usefulness of the external distraction system and in refining the midface distraction procedure.

Adult↗
PubMed2001

Muscle fibre damage and regeneration resulting from surgical limb distraction.

Using an animal model of limb distraction, the extent of muscle fibre damage and atrophy resulting from distraction at two different rates (1.3 or 3.0 mm day(-1)) was investigated. It was found that at the high rate of distraction there was a significantly greater loss of range of joint movement and more muscle fibre atrophy and fibre damage than at the low rate. Muscle fibre damage is usually followed by regeneration. This involves the expression of the neonatal form of myosin heavy chain, which can therefore be used as an indicator of regeneration. It was found that whilst many more fibres showed evidence of damage at the high compared to the low rate, the number of fibres expressing neonatal myosin was significantly reduced, indicating the presence of a population of fibres which was undergoing degeneration without subsequent regeneration. Thus it would appear that beyond a certain rate of distraction, regeneration may be insufficient to replace contractile material damaged by overstretching. It is suggested that these fibres are replaced with connective tissue. This process may contribute to the muscle weakness and loss of range of joint movement which sometimes accompanies limb distraction procedures.

Animals↗
PubMedDate not supplied

Comparative morphofunctional investigation of vascular pool of the muscles of the elongated extremity using different distractional regimens.

Morphofunctional changes in intra-organ vessels of dogs' muscles were evaluated by rheovasography and stereometry methods of muscular preparations to reveal ATP-ase, biochemical methods were used to determine tissue metabolism indices during elongation of tibia using different distractional regimens 1 mm 4 times per day (manual adjustment) and 1 mm 60 times per day (automatic distraction). The data obtained demonstrate different mechanisms for adequate intra-organ blood circulation in muscles using different distractional regimens.

Animals↗
PubMed2002

[Homeostasis and paravasal damper structures in intact and damaged nerves and long tubular bones].

Sciatic and tibial nerves and a femoral osteotomic area were investigated in experiments on 36 adult mongrel dogs during neutral and distractional osteosynthesis. Histological and X-ray studies, computer-assisted image analysis, and statistical methods were used. The morphological basis of hemodynamic features of the nerves and long tubular bones was characterized. The mechanisms responsible for perivascular osteogenesis in the bone marrow cavity and for hypertrophy of perineural cell paravasal spongy structures in the nerves were studied as compensatory and adaptive responses to changes in the hemodynamical components of homeostasis after bone injury and during extremity stretching.

Animals↗
PubMed1999

[Pseudarthrosis].

Understanding the pathophysiology of non-union is a prerequisite for successful treatment of this disorder. Fracture healing may be impeded by mechanical or biological factors as well as a combination of these. A thorough evaluation of each individual case before surgery is necessary to prevent either undertreatment or overtreatment. The whole spectrum of methods of internal fixation may be utilized for stabilization. To optimize the biological component, classic methods such as decortication and cancellous autograft may be employed. It is too early yet to determine if alternative techniques (e.g. ultrasound) will successfully replace these long-standing options. In any case, these newer modalities cannot supplant the need for skeletal stabilization. For infected pseudarthroses the first step is eradication of infection, after which measures can be taken to unite the fracture. Callus distraction has opened new and safe ways to treat large bone defects.

Biomechanical Phenomena↗
PubMed2004

[Principles of callus distraction].

Callus distraction is based on the principle of regenerating bone by continuous distraction of proliferating callus tissue. It has become the standard treatment of significant leg shortening and large bone defects. Due to many problems and complications, exact preoperative planning, operative technique and careful postoperative follow-up are essential. External fixators can be used for all indications of callus distraction. However, due to pin tract infections, pain and loss of mobility caused by soft tissue transfixation, fixators are applied in patients with open growth plates, simultaneous lengthening with continuous deformity corrections, and increased risk of infection. Distraction over an intramedullary nail allows removal of the external fixator at the end of distraction before callus consolidation (monorail method). The intramedullary nail protects newly formed callus tissue and reduces the risk of axial deviation and refractures. Recently developed, fully intramedullary lengthening devices eliminate fixator-associated complications and accelerate return to normal daily activities. This review describes principles of callus distraction, potential complications and their management.

Bony Callus↗
PubMed2000

Healing process after alveolar ridge distraction in sheep.

OBJECTIVE: Mandibular augmentation by distraction of the alveolar ridge has been in use for several years. Since 1996, a distraction device that remains in the alveolar ridge after distraction has been used by the Department of Oral and Maxillofacial Surgery of Graz University. The distraction device is transformed into a dental implant after the end of the distraction process and can later be used for prosthetic purposes. We aimed to show the application of the device in this animal experiment and to follow the osseous healing process. STUDY DESIGN: Two distraction implants were inserted into the mandibles of 8 sheep. Distraction of 0.5 mm per day was carried out for 8 days. Two sheep were killed 1, 2, 3, and 6 months after distraction, and the dissected mandibles were examined clinically, radiologically, and histologically. RESULTS: After the first month of distraction, only slight radiopacity of the distraction gap was found. This increased steadily up to the third month after distraction. The boundary between the distraction fragments and the gap disappeared gradually. Six months after distraction, a homogeneous fine-meshed spongiosa structure was found in the area of distraction. Histologic examination showed desmoid ossification in the distraction gap and a continued increase in osteoid. After 6 months, mature bone was found. Only in the center was the rebuilding process not complete. Six months after distraction, osseointegration of the implants was shown in the region of the screw thread and distraction cylinder. CONCLUSIONS: The healing process corresponded to that found in long bones, but showed only desmal ossification. Osseous integration of the distraction implants was found 6 months after distraction, although the implants were stable 3 months after distraction.

Alveolar Ridge Augmentation↗
PubMed2006

Mini external fixation in the hand.

External fixation is an effective means of addressing several pathologies of the hand. The advantages of its use include the ability to achieve stable fixation, minimize soft tissue trauma at the site of injury, and allow wound care and mobilization of adjacent joints. External fixators can be constructed from material readily available in the operating room or obtained from a commercial source. Sufficient rigidity can be achieved by any of these means. Improper placement, although achieving rigid fixation, may compromise motion and overall function if basic principles of external fixation are not followed or if the anatomy of the hand is not taken into consideration. The objective of this article is to describe the technique of application of mini external fixation, emphasizing the basic principles of external fixation as they relate to the specific anatomy of the hand. In addition to fracture fixation, various other uses are described including distraction lengthening, arthrodesis, treatment of nonunion, and infection.

Arthrodesis↗
PubMed1999

Implant anchorage for the occlusal management of developmental defects in children: a preliminary report.

Congenital anomalies and developmental defects of the face and jaws often present orthodontic anchorage challenges in which the residual dentition cannot be adequately positioned for restorative objectives. This article presents a method of classification for the formulation of implant-based treatment protocols in children, reviews the application of implants in the developing dentition, and provides guidelines for occlusal treatment. Procedures performed according to the protocols outlined in this article will facilitate orthodontics and orthopedic movement and accelerate three-dimensional jaw movement by sutural distraction of basal bone.

Adolescent↗
PubMedDate not supplied

Vertical alveolar ridge distraction with prosthetic treatable distractors: a clinical investigation.

Alveolar ridge distraction is a recent and promising technique for ridge augmentation. Since 1997, a new distraction system incorporating a distraction implant has been in use. It can be used for alveolar ridge distraction and is not removed from the alveolar ridge. Upon completion of the distraction, it remains in the alveolar process for later prosthetic treatment. Thirty-five patients were treated with distraction implants for the correction of alveolar ridge deficiency. In 10 patients with atrophy of the mandible or maxilla, 16 patients with severe defects of the alveolar process after trauma, and 9 patients with localized alveolar ridge defects after single tooth loss, alveolar ridge distraction was carried out with the aid of 62 distraction implants. The distraction implants were loaded by prosthetic superstructures 4 to 6 months after distraction. A clinical and radiologic follow-up was carried out. Periotest values were examined, and peri-implant bleeding and probing depth were registered prior to prosthetic treatment and 3, 6, and 9 months after implant loading. In 29 patients, distraction was carried out without complications or problems. Two distraction implants were lost. In 2 patients distraction was discontinued because of ankylosis of the distraction segment. In 1 patient the alveolar ridge was overcorrected, and another patient experienced a persisting hypoesthesia of the lip. For 5% of the implants, pathologic probing depth of more than 3 mm and sulcus bleeding were registered prior to prosthetic treatment. These observations decreased during the next 9 months. Periotest values were normal before the start of prosthetic treatment. There was a decrease in the Periotest values, thus an increase in implant stability, during the following 9 months. It was concluded that alveolar ridge distraction using distraction implants can be a successful technique for alveolar ridge augmentation with a low rate of complication. Acceptable esthetic and functional results can be achieved by this atraumatic technique of surgery and distraction.

Adolescent↗