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PubMed2004

[Orthodontic treatment of children with cleft lip and cleft palate].

Orthodontic treatment of children with cleft palates continues through the periods of the three dentitions: temporary, mixed, and adult. Using examples, this paper deals with the different difficulties that can be encountered during treatment of this malformation. Orthodontic interception at the time of the temporary dentition corrects the heart of the problem, the transverse insufficiency, but also addresses moderate maxillary retrusion. Cooperation with a speech therapist at this stage is essential. In the mixed dentition, orthodontists correct incisal malalignment and, depending upon the severity of the deformity, consider surgical intervention. In the adult dentition, a variety of decisions must be made: whether to open or close the spaces left by absent lateral incisors; whether to accept an orthodontic compromise or to elect surgical advancement of the maxilla; and, if surgery is deemed appropriate, whether to embark on an early distraction procedure or to rely on a classical osteotomy.

Adolescent↗
PubMed2003

Ultrasound stimulation of maxillofacial bone healing.

A substantial part of the maxillofacial surgery practice deals with maxillofacial bone healing. In the past decades, low-intensity ultrasound treatment has been shown to reduce the healing time of fresh fractures of the extremities up to 38%, and to heal delayed and non-unions up to 90% and 83%, respectively. Based on the assumption that the process of bone healing in the bones of the extremities and maxillofacial skeleton is essentially the same, the potential of ultrasound to stimulate maxillofacial bone healing was investigated. Although limited evidence is available to support the susceptibility of maxillofacial bone to the ultrasound signal, ultrasound may be of value in the treatment of delayed unions, in callus maturation after distraction, and in the treatment of osteoradionecrosis.

Animals↗
PubMedDate not supplied

Complications following metatarsal lengthening by callus distraction for brachymetatarsia.

We performed six metatarsal lengthenings in four patients for brachymetatarsia of the fourth toe by callus distraction from 1991 to 1995. Healing was achieved in all cases. The average amount of lengthening was 30% (range, 15-41%) of the original length. The average healing index was 82 days/cm (range, 66-113 days/cm). After the operation, range of movement of the metatarsophalangeal joint decreased in all cases (120 degrees before and 57 degrees after surgery). In two cases in which the lengthening exceeded 40% of the original length, stiffness of the joint (20 degrees and 0 degrees each) and joint deformity occurred. These two cases also had angulation of the metatarsal. Corrective osteotomy and release surgery was performed in one case. Angulation of the metatarsal was corrected, but the range of movement of the joint did not much recover after surgery. Another case was left untreated because the patient had no complaints. In metatarsal lengthening by callus distraction, the amount of lengthening should not exceed 40% of the original length.

Adolescent↗
PubMed2003

Orthodontic fine adjustment after vertical callus distraction of an ankylosed incisor using the floating bone concept.

The outcome of vertical callus distraction of a segment of tooth-supporting alveolar process might be functionally and esthetically unsatisfactory because of the unidirectional impact of intraoral distraction devices. In this case report, we describe how, with a shortened consolidation phase and application of the floating bone effect, the tooth-supporting osteotomy segment can be successfully aligned 3 dimensionally. We applied orthodontic force systems that went beyond the unidirectional vector preset by the mechanical properties of the distraction device.

Alveolar Process↗
PubMed2000

Calcaneocuboid distraction arthrodesis for posterior tibial tendon dysfunction and flatfoot: a cadaveric study.

Nine fresh-frozen foot specimens were studied to determine the mechanical behavior of the foot using calcaneocuboid distraction arthrodesis, an operation designed for treatment of posterior tibial tendon dysfunction with flatfoot deformity. Flatfoot deformity was created in cadaveric specimens, and to simulate toe-off phase of gait, loads were applied to the plantar surface of the foot and six tendons. Three-dimensional tarsal bone positions were determined with a magnetic tracking system. With ligament sectioning, flatfoot deformity was observed and average arch height decreased 53 +/- 3.5 mm. Height arch increased after calcaneocuboid distraction arthrodesis an average of 3.2 +/- 3.6 mm and was less than normal arch at an average of 2.1 +/- 2.4 mm. Metatarsotalar alignment compared with flatfoot improved after calcaneocuboid distraction arthrodesis in adduction and inversion to the extent that these were not significantly different from intact foot positions. Calcaneotalar position improved after calcaneocuboid distraction arthrodesis in adduction and inversion. Calcaneocuboid alignment compared with flatfoot improved after calcaneocuboid distraction arthrodesis in adduction, plantar flexion, and eversion, but compared with an intact foot was overcorrected in all three planes of motion. Arch alignment in simulated toe-off phase of gait in cadaveric feet was improved significantly with calcaneocuboid distraction arthrodesis but was not reduced anatomically.

Aged↗
PubMed1998

Frontoorbital advancement by gradual distraction. Technical note.

A substantial number of patients with coronal synostosis who undergo frontoorbital advancement still require additional surgical treatment to correct increased intracranial pressure or unsatisfactory craniofacial structure. However, frontoorbital advancement currently requires elevation of the frontal as well as the orbital bone, which can result in a fragile dura mater and partial resorption of the advanced bone. Thus the dura is easily torn by dissection and the advanced bone is further resorbed and deformed during repeated craniofacial operations. To avoid these drawbacks and to create an easier second surgical treatment via the intracranial approach, a new technique for frontoorbital advancement is presented. In this technique frontoorbital bone is advanced as a single unit, without elevation from the underlying dura, by means of gradual distraction. The details of the technique and an illustrative case are reported.

Cranial Sutures↗
PubMed2003

[Three-dimensional modeling of mandibular distraction].

Facial hemi-atrophy affects 1 in 4000 or 5000 children. We propose treating this deformation of the 1st branchial arch with the "bone distraction" lengthening technique first described by Ilizarov in the 1950s, which has already been employed with the mandible. We have modelled mandibular distraction in facial hemi-atrophy patients and discuss the benefits of such pre-surgical planning encompassing the assistance of pre- and post-operative as well as surgically coordinated orthodontic therapy. Using X scanner views of a 5 year-old girl patient, we have developed a distraction-simulation software, which makes the pathological side harmonious with the healthy side along the medial sagittal plane. In order to obtain facial symmetry, put bones in balance, and orient the occlusal plane horizontally, essential requisites of occlusal stability, it is necessary: to employ a 2 or 3-dimensional distractor, to pre-plan the distraction and screw positioning, to set up a fixed orthodontic treatment plan prior to beginning distraction therapy.

Child, Preschool↗
PubMed2000

[Callus distraction of the mid-face in severe mid-face hypoplasia].

Callus distraction in the treatment of severe midfacial hypoplasia/atrophy may offer new therapeutical possibilities. Between May 1998 and March 1999, six patients underwent a subtotal Le Fort I-II osteotomy with subsequent distraction via a haloborne distractor (RED). Five patients suffered from CLP, four patients were totally or almost edentulous in the upper jaw. Corrections of sagittal discrepancies were possible in all cases (distraction 16-31 mm). No case of increased velopharyngeal insufficiency was seen. In one patient the halo had to be refixed. Three patients suffered from tension-like pain in the soft palate during distraction. Follow-up studies suggest the necessity for overcorrection of 20% in edentulous senior patients. Callus midfacial distraction is a promising new alternative to conventional orthognathic surgery in severe cases.

Adolescent↗
PubMed2002

[Possibilities and limitations of ultrasonography in corticotomy/callus distraction].

Sonographic examination can yield additional information free of radiation in the course of corticotomy/callus distraction. The echogenic structures of the cortical structure and the callus between can be scanned at the area of the callus distraction by ultrasound examination. Individual sectional planes are focussed. They are different from the standardized ultrasound examination. Depending on when the corticotomy was performed, the callus between the cortical structures can be visualized sonographically. First it is echo poor, and then it becomes more and more echogenic. The ultrasound examination can give additional information during the first 4 weeks after corticotomy/callus distraction. A deviation of the axis in the area of callus distraction cannot be judged reliably. A sonographically guided division into three stages is possible.

Bony Callus↗
PubMed2005

Nonsurgical treatment with rapid mandibular canine retraction via periodontal ligament distraction in an adult with a Class III malocclusion.

A woman with a Class III malocclusion was a poor candidate for orthognathic surgery. An orthodontic treatment plan was developed that incorporated a relatively new and rapid process of canine distraction. The mandibular first premolars were extracted, correcting the anterior crossbite, the Class III canine relationship, and the Class III facial appearance. The canines were distracted, through the periodontal ligament, into the extraction sites. Dental distraction is a breakthrough for orthodontics, especially for adults with critical anchorage requirements.

Adult↗
PubMed2003

Correlation of biomechanical stiffness with plain radiographic and ultrasound data in an experimental mandibular distraction wound.

The aim of this study was to determine the stiffness of a porcine mandibular distraction wound at the end of neutral fixation.Twenty-four Yucatan minipigs underwent unilateral mandibular distraction: zero-day latency, rates of 1, 2, and 4 mm per day, distraction gap of 12 mm. Radiographic and ultrasound bone fill scores at 0, 8, 16 and 24 days of neutral fixation were used to evaluate interval healing. At sacrifice, biomechanical stiffness was determined using an Instron machine to produce a downward force of 2 mm/min at the premolar occlusal surface. Force (kilo-Newton, kN) and displacement (mm) were recorded at a rate of 10,000 points/second. Stiffness across the distraction wound, plain radiographic and ultrasound bone fill scores all increased with duration of neutral fixation and were highest for the 1 mm per day group at all time points. At the end of fixation, even in the most clinically stable group, stiffness across the distraction wound was only 25.5% of control.Despite clinical stability and high bone fill scores by X-ray and ultrasound, the distraction wound did not achieve normal stiffness at the end of neutral fixation in this model. This may have implications for the management of patients who undergo large movements by distraction.

Animals↗
PubMed1998

Spring mediated dynamic craniofacial reshaping. Case report.

A new technique of using implantable springs as an adjunct after corrective surgery for craniofacial malformations is presented. A 6-month-old boy with multiple premature craniosynostoses and extreme turricephaly underwent surgery of limited extensiveness but supplemented with a set of indwelling springs for gradual postoperative skull reshaping. At spring removal three months later the skull was normalised both clinically and on cephalogram. A 5-year-old boy with Apert syndrome, severe midface retrusion, exorbitism, and sleep apnoea underwent a monobloc full face disjunction without repositioning, but was fitted with two springs for postoperative facial advancement. Three months postoperatively cephalometric analysis revealed 14 mm advancement at incisor level and at least 16 mm in the frontal region. There was no more exorbitism or clinically noticeable midface retrusion. Sleep studies revealed that the sleep apnoea was significantly improved, meaning complete cure except when sleeping flat on the back. It was concluded from these first clinical applications of spring assisted craniofacial distraction that springs hold significant promise for the future in many respects.

Acrocephalosyndactylia↗