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PubMed2003

Mandibular symphyseal distraction and its geometrical evaluation: report of a case.

In this report, the case of a patient who has been treated with a different use of a tooth-borne custom-made mandibular symphyseal distraction device is presented. The difference in the application is that the distal arm of the device was sectioned during the retention phase to allow the possible relapse of displaced condyles to their original positions while the labial segment expansion is being maintained. The effect of this procedure was also evaluated on a geometrical model using measurements from the patient's cast. We conclude that symphyseal distraction is an effective and fast method of correcting orthodontic anomalies. The effect of the procedure on the condyle was only 3 degrees of distolateral rotation as calculated using the geometrical model.

Adolescent↗
PubMed2001

Shortening of mandibular linear distance with multivector distraction.

It was noted that when a multivector distractor is used, there is shortening of the linear distraction distance when the gonial angle is reduced and the transverse distance is increased. The purpose of this study was to measure the distance change at the mandibular corticotomy site when the gonial angle is reduced or the transverse distance is increased. The Synthes multivector distractor was used in this experiment. After initial linear distraction, the distractor was activated by angular and transverse adjustments to achieve an angular, a transverse, and a combined angular and transverse reorientation. The length of the pin from the distractor to the tip of pin was evaluated at 15, 20, and 25 mm. With the pins place at 180 degrees , the distractor arm length was evaluated at 30, 35, 40, 45 and 50 mm apart, respectively. The distance change between the ends of the pins was measured by means of a caliper. For angular activation, one turn shortened the linear distraction distance at the pin end by 1.5 to 2.2 mm. For transverse activation, one turn shortened the linear distraction distance by 1.1 to 2 mm. For combined angular and transverse activation, one turn of angular activation plus one turn of transverse activation shortened the linear distraction distance by 2.2 to 3.2 mm. For angular activation, increasing the pin length did not alter the distance between the pin ends for any of the specific activations. Increase in the distractor arm length in angular reduction resulted in significant increase in the shortening. For transverse increase, alteration in the distractor arm length resulted in the same shortening. Increase in the pin length resulted in increased shortening at the pin ends. When the transverse and angular activation were combined, the shortening was 80% of the combined measurements. The distance between the pin ends will reflect the distance between the bone segment at that site. It will be different at the outer cortex of the bone. These measurements will be valuable in planning the extent of additional linear distraction needed, when the angle is reduced or transverse distance is increased with the use of a multivector distractor. Alteration in the distractor arm length and pin length has a significant effect on the extent of shortening.

Biomechanical Phenomena↗
PubMed1999

Early decannulation with bilateral mandibular distraction for tracheostomy-dependent patients.

Obstructive sleep apnea in the neonatal period may originate from a hypoplastic mandibular framework causing retroposition of the base of the tongue and an inadequate hypopharyngeal space. A tracheotomy in childhood is an effective treatment for obstructive sleep apnea, but it is associated with increased morbidity, management problems, and difficulties in social interaction. Tracheostomy-dependent pediatric patients who underwent mandibular distraction were reviewed to determine the effectiveness of this technique in achieving decannulation. A clinical review was completed to determine the status of the tracheostomy after external, unidirectional distraction in tracheostomy-dependent patients. Expansion of the mandibular framework was analyzed using traditional bony landmarks on predistraction and postdistraction lateral cephalograms. The area of the lower face was analyzed, and changes in the position of the hyoid bone were determined. Four patients with tracheostomies underwent an average of 21.3 mm and 20.8 mm of distraction on the left and right hemimandibles, respectively. The average age at the time of distraction was 2.7 years (range, 2.2 to 3.2 years). All patients underwent successful decannulation at an average of 3.8 months (range, 1.5 to 5.5 months) after completion of distraction. The area of the lower face increased 26.9 percent (range, 12.2 to 53.5 percent) after distraction, and the hyoid bone advanced an average of 14.5 mm (range, 8 to 25 mm). Bilateral mandibular distraction is an effective method of expanding the mandibular framework and concomitantly advancing the base of the tongue. The technique provides a tool for early intervention and decannulation in pediatric patients with indwelling tracheostomies secondary to mandibular deficiencies.

Cephalometry↗
PubMed2003

Knee arthrodesis after infected tumor mega prosthesis of the knee using an intramedullary nail for callus distraction.

BACKGROUND: Infected tumor endoprosthesis of the knee in young patients can prove to be challenging. Common procedures are débridement and prosthesis reimplantation, amputation, revision arthroplasty, and arthrodesis. CASE PRESENTATION: We report the case of a 44-year-old man treated by arthrodesis followed by callus distraction after removal of an infected tumor mega prosthesis (Kotz type). Callus distraction was performed over a distance of 11 cm in 4 months using a femorotibial intramedullary nail with an external traction rope-winch system. METHODS AND FOCUS: The clinical, radiological, technical, and therapeutic features are discussed.

Adult↗
PubMed2002

A method of skeletal anchorage for maxillary distraction.

A simple method of providing skeletal anchorage in maxillary distraction is described. The method utilizes cheap and readily available miniplates and provides rigid fixation to the fragment. It can be utilized at multiple levels in high-level osteotomies and situations with an inadequate dentition for anchorage.

Bone Plates↗
PubMed2005

Intraoral distraction of a patient with premaxilla agenesis.

The complex disharmonies which affect the maxillofacial region, in the sagittal and vertical dimensions, can find further complications due to the deficit of maxillary osseous tissue in transversal direction. Surgery can be indispensable to correct the malocclusion. Various methodologies have been developed for the correction of transversal maxillary hypoplasia. Among these, the Authors mention the intraoral distraction for the treatment of a male patient with pre-maxilla agenesis and serious contraction of the upper maxillary. A particularity of this case is represented by the occurred transversal skeletal expansion, starting from a past scar, outcome of a previous surgery.

Adult↗
PubMed1998

Index finger lengthening by gradual distraction and bone grafting.

We present the case of an 18-year-old woman with a shortened right index finger. The digit was stabilized and lengthened a total of 18 mm by external fixation and iliac bone grafting. A distal interphalangeal fixed flexion deformity of 60 degrees was corrected with external fixation and intermedullary wiring.

Adolescent↗
PubMed2004

Osteoblastic activity and neoangiogenesis in distracted bone of irradiated rabbit mandible with or without hyperbaric oxygen treatment.

The effects of irradiation and hyperbaric oxygenation (HBO) on osteoblastic activity and angiogenesis in rabbit mandibular distraction (DO) were evaluated. Three groups were studied. The mandible of two groups received a 22.4Gy dose of irradiation. One of the irradiated groups was also given HBO, 18 times at 2.5ATA for 90min per day preoperatively. The third group was given neither radiotherapy nor HBO. Mandibular lengthening was performed unilaterally. Osteoblastic activity was assessed ex vivo by [18F]fluoride digital autoradiography. Neovascularization of distracted bone was evaluated histomorphometrically. Osteoblastic activity was higher in non-irradiated than irradiated animals. In non-irradiated rabbits, the activity was evenly distributed over the distraction area. In the irradiated groups, the activity was greater in the central third of the lengthened bone than the peripheral thirds. HBO changed the osteogenic pattern towards that of non-irradiated bone. In the non-irradiated group the number of blood vessels was 1.7-fold as compared to irradiated rabbits without HBO (P=0.0012), and the fewest number of vessels was found in irradiated rabbits without HBO. Blood vessels were more numerous in the central region than in peripheral regions in non-irradiated animals and irradiated animals with HBO, but not in irradiated rabbits without HBO therapy. It is concluded that radiotherapy disturbs distraction bone formation and neovascularization related to DO. HBO increases osteoblastic activity, but not to the level of non-irradiated bone. Angiogenic response is markedly increased by HBO.

Analysis of Variance↗
PubMed2004

Neonatal distraction surgery for micrognathia reduces obstructive apnea and the need for tracheotomy.

The objective of the study was to assess the effectiveness of neonatal mandibular distraction in treatment of obstructive sleep apnea in the perinatal period in preventing a tracheotomy. This was a prospective study of 17 infants at two centers with severe micrognathia who demonstrated obstructive sleep apnea refractory to conservative therapy. Age at surgery varied from 5 to 120 days. Distraction was performed at a rate of 2 mm/d. After distraction, callus consolidation was allowed for 4 to 6 weeks, and the device was then removed. Each child underwent a three-dimensional computed tomography scan before surgery and approximately 3 months after surgery. Of the 17 patients, 14 successfully underwent extubation and demonstrated significant improvement in the obstructive sleep apnea. Postoperative horizontal ramus length increased from 23.3 to 34.8 mm after surgery. Mean maxillary mandibular discrepancy was 8.28 mm before surgery and 2.2 mm after surgery. Ten infants who underwent pre- and postoperative polygraphic studies showed improvement in obstructive apnea. Three patients had postoperative polysomnographic studies only; the results were also within the normal range. The mean follow-up interval was 16.5 months (range: 8-48 months). Neonatal distraction is an effective method for treatment of micrognathia with obstructive sleep apnea in the perinatal period in preventing a tracheotomy.

Airway Obstruction↗
PubMed2006

Disc distraction shows evidence of regenerative potential in degenerated intervertebral discs as evaluated by protein expression, magnetic resonance imaging, and messenger ribonucleic acid expression analysis.

STUDY DESIGN: An animal model of degeneration was used to determine the effects of disc distraction, and was evaluated with magnetic resonance imaging (MRI) as well as gene and protein expression levels. OBJECTIVE: To investigate gene expression and MRI effects of distraction. SUMMARY OF BACKGROUND DATA: Disc degeneration can result from hyper-physiologic loading. Distracted discs with degeneration showed histologic signs of tissue recovery. METHODS: There were 18 rabbits that underwent 28 days of compression (200 N) to induce moderate disc degeneration followed by 28 days of distraction (120 N; attached and loaded distraction device) or sham distraction (attached but unloaded distraction device). Comparison was performed with 56 days of compressed discs without distraction. Quantitative outcome measures were MRI signal intensity and gene expression analysis to determine: messenger ribonucleic acid levels for extracellular matrix genes, including collagen 1, collagen 2, biglycan, decorin, aggrecan, fibromodulin, and osteonectin; and matrix-regulative genes, including matrix metalloproteinase-13, tissue-inhibitor of matrix metalloproteinase-1, and bone morphogenetic protein (BMP)-2. Immunohistology was performed for collagen 2 and BMP-2 to label cells semiquantitatively by staining of the cell-surrounding matrix. RESULTS: A total of 28 days of compression decreased signal intensity. Distraction over the same period reestablished physiologic signal intensity, however, a persistent reduction was found in sham distraction. Distraction resulted in gene expression up-regulation of collagen 1 (5.4-fold), collagen 2 (5.5-fold), biglycan (7.7-fold), and decorin (3.4-fold), while expression of fibromodulin (0.16-fold), tissue-inhibitor of matrix metalloproteinase-1 (0.05-fold), and BMP-2 (0.15-fold) was decreased, as compared with 56 days compression. Distracted discs showed more BMP-2 (19.67 vs. 3.67 in 56 days compression) and collagen 2 (18.67 vs. 11.33 in 56 days compression) positive cells per field. CONCLUSIONS: Distraction results in disc rehydration, stimulated extracellular matrix gene expression, and increased numbers of protein-expressing cells.

Animals↗
PubMed2004

Tibial lengthening over nails in children using modified Ender nails: preliminary results of a new treatment.

Tibial lengthening over nails, using modified Ender nails, was performed in nine children whose mean age at surgery was 12.8 years. The prerequisite for using this technique was the absence of axial malalignment and an indication for tibial lengthening only. Lengthening was not performed in one case due to the development of a compartment syndrome after the tibial osteotomy. Breakage of one interlocking screw without loss of alignment or length was observed in one case. Superficial pin tract infections were observed in two cases. An average of 4.1 cm (range 3-4.5 cm) lengthening of the tibia was achieved in eight of the nine cases. The modified Ender nails used permitted locking at both ends after achieving the desired distraction and permitted early removal of the external fixator. The advantage of this technique is that it permits early removal of the fixator and thus decreases the incidence of fixator related problems and facilitates early rehabilitation.

Adolescent↗
PubMed2000

Osteogenic distraction within the craniofacial complex.

Osteogenic distraction is a method of increasing bone length, and was developed by orthopaedic surgeons. It is now being used in the craniofacial region. This paper outlines some of the suggested uses: mandibular distraction can be used to correct hypoplasia and asymmetry in both children and adults; maxillary distraction can bring the midface forward, and holds potential for people with cleft lip and palate; augmentation of alveolar ridges and regeneration of mandibular tissue following tumour resection show considerable promise. The complex spatial dimensions of the craniofacial bones present considerable challenges for this developing technique.

Adult↗
PubMed1997

Lower-limb lengthening in short stature. An electrophysiological and clinical assessment of peripheral nerve function.

We assessed peripheral nerve function during and after lower-limb lengthening by callotasis in 14 patients with short stature, using motor conduction studies. Four patients with short stature of varying aetiology showed unilateral and one showed bilateral weakness of foot dorsiflexion. Both clinical and electrophysiological abnormalities consistent with involvement of the peroneal nerve were observed early after starting tibial callotasis. There was some progressive electrophysiological improvement despite continued bone distraction, but two patients with Turner's syndrome had incomplete recovery. A greater percentage increase in tibial length did not correspond to a higher rate of peroneal nerve palsy. The function of the posterior leg muscles and the conduction velocity of the posterior tibial nerve were normal throughout the monitoring period. The F-wave response showed a longer latency at the end of the bone distraction than in basal conditions; this is probably related to the slowing of conduction throughout the entire length of the nerve.

Achondroplasia↗
PubMed2005

Horizontal distraction of the anterior maxilla in combination with bilateral sinuslift operation--preliminary report.

In many cases alveolar ridge atrophy causes severe alveolar ridge deficiency in horizontal and vertical direction. In cases of severe atrophy of the edentulous maxilla a maxillary retrognathism results. In this article, a new technique of solving this problem prior to implant placement is described. In six patients with severe atrophy of the edentulous maxilla a sinuslift operation and placement of dental implants were carried out in the posterior maxilla. In the anterior part of the maxilla a segmental split osteotomy and placement of two miniplate distractors were performed. One week after surgery distraction started with a distraction speed of 0.5 mm a day until a clinical correct position of the anterior maxilla resulted. Then, the stabilisation period of 12 weeks followed before the distractors were removed and two to four implants were placed in the anterior distracted maxilla. After a second healing period of 4 months the implants were used for loading by a fixed prosthetic superstructure. Six patients were treated by this regime and 58 implants were placed. All implants were loaded by a fixed prosthesis. Distraction was performed without disturbances. Three months after healing new bone was formed in the distraction gap. There was no implant loss. An aesthetic satisfying superstructure with good red and white aesthetics was achieved together with a correct interalveolar relation. Distraction of the anterior part of the maxilla in combination with sinuslift operation is an alternative technique for correction of interalveolar incongruences in the edentulous maxilla and augmentation prior to implant placement.

Bone Substitutes↗
PubMedDate not supplied

A functional classification of spinal instrumentation.

BACKGROUND CONTEXT: Spinal instrumentation systems have evolved far beyond the original Harrington design, with increasing complexity and capabilities. This review attempts to de-emphasize the "product names," as systems are often generically and inappropriately referred to as "Harrington rods," by introducing a functional classification for current systems. PURPOSE: The aim of this paper is to review the intended design purpose of current spinal instrumentation systems for more accurate interpretations of radiographs and complications. STUDY DESIGN: The principles involved in each type of instrumentation system are described, followed by the characteristic components and the normal appearance radiographically, with examples of complications, which should be recognized. METHODS: The historical contribution of specific systems in the developing art of internal fixation of the spine is provided as a background to understand the biomechanical forces imparted by spinal hardware. Recognizing the functional intent of spinal constructs will enhance descriptions of those images. RESULTS: Spinal instrumentation has been categorized into five functional types: Distraction and compression, segmental stabilization, coupled or derotation systems, translational or pedicle screw systems, and anterior instrumentation. CONCLUSIONS: Analysis of radiographs from a functional viewpoint can enhance the descriptive interpretation and specifically allow assessment of the success or of the presence of complications, which are crucial to the analysis of instrumentation effectiveness.

Equipment Design↗
PubMed2002

Osteogenic distraction and orthognathic surgery to correct sequelae of ankylosis of the temporomandibular joint: a case report.

A 17-year-old female patient presented with sequelae to ankylosis of the temporomandibular joint, which included vertical maxillary protrusion, anterior open bite, labial incompetence, micrognathia, undefined neck angle, facial asymmetry, Class II molar relationship, and Class III canine relationship. She presented with the following cephalometric and soft tissue data: SNA angle = 78 degrees, SNB angle = 70 degrees, incisor-nasion-point A = 11 degrees, incisor-nasion-point B = 33 degrees, Frankfort-mandibular plane angle = 43 degrees, occlusal plane = 25 degrees, subnasale-stomion = 20 mm, stomion superius-stomion inferius = 9 mm, stomion inferius-soft tissue menton = 30 mm, neck angle = 144 degrees, and chin projection = 10 mm. Orthognathic surgery and mandibular osteogenic distraction were employed, specifically Le Fort I osteotomy to decrease a vertical excess of 12 mm, augmentation genioplasty of 17 mm, and bilateral extraoral distractors of bidirectional vector for a 14-mm augmentation of the mandible. The result was satisfactory with minimal adverse complications.

Adult↗
PubMed2006

Relief of upper airway obstruction with mandibular distraction surgery: Long-term quantitative results in young children.

OBJECTIVE: To evaluate the long-term benefits of mandibular distraction on sleep-related upper airway obstruction in young children with mandibular hypoplasia. DESIGN: Cross-sectional study. Subjects were examined for sleep-disordered breathing using medical history, physical examination results, and a written questionnaire. Subjects underwent standard overnight polysomnography, during which measures of sleep-disordered breathing were collected. SETTING: Tertiary care hospital. PATIENTS: Five children with upper airway obstruction from craniofacial anomalies treated with mandibular distraction, with a minimum follow-up of 12 months. MAIN OUTCOME MEASURES: Apnea-hypopnea index, oxygen saturation nadir, and peak end-tidal carbon dioxide value. RESULTS: Of the 5 children, 3 were cured of upper airway obstruction as documented by polysomnography, with an apnea-hypopnea index of less than 1.5 and no snoring. The fourth child had primary snoring without apnea. The fifth child had severe obstructive sleep apnea, with an apnea-hypopnea index of 20.2. CONCLUSIONS: Most children who undergo mandibular distraction for upper airway obstruction associated with mandibular hypoplasia demonstrate significant clinical improvement of obstructive sleep apnea. However, those children who continue to have symptoms of sleep-disordered breathing after surgery should undergo polysomnography for evaluation of persistent obstructive sleep apnea.

Craniofacial Abnormalities↗
PubMed2001

Metacarpal and phalangeal lengthening by callus distraction.

Twelve metacarpals and two phalanges in 14 patients (nine males and five females) were lengthened between August 1992 and March 1999 by the callus distraction technique using a small external fixator (Orthofix). The indications were traumatic amputation (10 cases), aplasia (three cases) and hypoplasia owing to premature epiphyseal closure of the metacarpal (one case). All patients were reviewed with a median follow-up time of 39 (range, 9-88) months. The median age of the patients was 15 (range, 4-39) years. The median lengthening was 21 (range, 13-34) mm which was a median of 82% (range, 38-162) of the original bone length. The median times for callus distraction and consolidation were 4.5 and 7.5 weeks respectively. All except one patient tolerated the procedure well and were satisfied with the results. Functional improvement was seen in 13 out of 14 patients, but non-union was observed in one patient.

Adolescent↗