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PubMed2004

Fronto-facial monobloc advancement with rigid external distraction (RED-II) system.

Fronto-facial monobloc advancement is one of the most rewarding procedures for upper and mid-face reconstruction in patients with craniosynostosis. However, it has challenging aspects. Epidural abscess and frontal bone necrosis after retrofrontal dead space is one of the major complications and has led many experienced surgeons not to continue with the procedure. Bone distraction can play a great role in preventing these problems. The Rigid External Distraction (RED-II) system is a external distraction device using the cranium as an anchorage point. In two craniosynostosis cases, fronto-facial monobloc advancement with the system was performed. Controllability of the monobloc segment increased significantly. Operative time and blood loss were lessened. No major complications were experienced.

Adolescent↗
PubMed2004

Introduction of a novel internal spring-driven craniofacial bone distraction device.

A study of craniofacial bone distraction using an internal self-expanding bone device designed by the authors was performed in a young rabbit skull model. Ten 30-day-old New Zealand white rabbits were divided into two groups: 5 underwent distraction with the device, and 5 served as controls. Serial cephalograms, defleshed skull measurements, and histological examinations were performed on the study animals. The distracted group demonstrated a significant midface lengthening and overbite compared with the control group. Histologically, more fibroblasts and osteoblasts were seen in the front nasal bone in the distracted group in comparison with the nondistracted controls. The self-expanding internal bone distractor can effectively lengthen certain facial bones in an animal model and avoid some of the disadvantages associated with the external distraction techniques. This new device offers clinical potential as a useful distraction technique, but further work is needed to determine the effects of continuous postoperative tension loads on bone healing, the amount of tension generated by certain spring loads and lengths, and the feasibility of applying this concept in confined bone spaces.

Animals↗
PubMed2006

Mandibular distraction of the body and ramus.

With the ever increasing interest in the field of osteodistraction techniques, the mandible is certainly the most studied anatomical site, both experimentally and clinically. Currently, the methods of mandibular distraction can be classified by position (intra- or extraoral), by the direction of distraction and by the site of application (toothborn, boneborn or hybrid fixation). To guarantee good results from the osteodistraction procedure, it is fundamental to have an accurate preoperative plan considering the correct classification and evaluation of the patient combined with a valid project regarding the direction of the distraction vector. One of the most important aspects to consider is the orientation of the distractor, especially if the defect to be corrected is three-dimensional. Regarding the correct planning of the operation, knowing the secondary effects of the distraction on the soft tissues, muscles and nerves, the temporomandibular joint and velopharyngeal functioning is of fundamental importance. It is worth considering particular situations in which osteodistraction is extremely helpful in maxillofacial surgery, for example in the construction of a neocondyle, in bone replacement during oncologic interventions, in obstructive sleep apnea correction and in hemi-mandibular reconstruction.

Humans↗
PubMed2006

K-wire transfixation or distraction following the Keller-Brandes arthroplasty in Hallux rigidus and Hallux valgus?

A total of 118 feet with Hallux valgus and Hallux rigidus treated by the Keller-Brandes method were re-examined clinically and radiologically after 9.1 years (range: 1.7-24.3). Correction of the Hallux valgus angle was obtained from an average of 40 degrees to 23 degrees in the Hallux valgus group. Improvement in the postoperative range of motion was observed when the aftertreatment consisted of Kirschner-wire distraction instead of an axial Kirschner-wire transfixation. The patients who underwent Keller-Brandes surgery for Hallux valgus had less pain when the aftertreatment was carried out using an axial Kirschner wire, while those operated on for Hallux rigidus had less pain when the aftertreatment consisted of distraction. The percentage of satisfied or very satisfied patients with the cosmetic results of the Keller-Brandes arthroplasty was more than 66.7%. Patients with Hallux valgus and postoperative aftertreatment with Kirschner wire transfixation were the most satisfied patients, while patients with Hallux rigidus were very satisfied with the postoperative distraction. Our good results are comparable to those in other studies and confirm the success of the Keller-Brandes resection arthroplasty in Hallux valgus with osteoarthritis of the first metatarsophalangeal joint in older patients whose demand for movement is less, and in Hallux rigidus in less active older patients.

Arthralgia↗
PubMed2004

Joint distraction for the treatment of ankle osteoarthritis.

Joint distraction has demonstrated substantial promise in the treatment of tibiotalar arthritis. Its minimally invasive nature, combined with the fact that it does not seem to "burn any bridges," lends considerable clinical appeal. Even if joint distraction provides only temporary relief and clinical results slowly deteriorate over time, more definitive and committed procedures potentially can be forestalled for a considerable period of time. Nevertheless, the current literature and clinical experience with this technique is limited. Further research and analysis is ongoing and will be necessary to understand, validate, and refine this novel approach to ankle arthritis.

Adult↗
PubMed2005

[Unfavorable influence of the dynamic neutralization system on sagittal balance of the spine].

PURPOSE OF THE STUDY: The dynamic neutralization system (Dynesis) has been proposed for the treatment of symptomatic lumbar discopathy. This system preserves the mobility of the instrumented vertebral segment and restores discal height by posterior distraction on pedicular screws, stabilization being ensured by compression on a spacer. The potential kyphosing effect of this system and the impact on sagittal morphology of the spine were analyzed. MATERIAL AND METHODS: Twenty-six patients were studied. Lateral x-rays of the lumbar spine in the upright position were obtained before and after the surgical procedure and at mean 9.5 +/- 3.3 months follow-up. Comparisons were made between the pre- and postoperative presentation with measurement of the pelvic and spinal sagittal parameters described by Duval-Beaupère: inclination of the pelvic segment on the sacrum, lordosis, and disc wedge angles at each level (particularly the instrumented levels). Sagittal morphology was assessed pre- and postoperatively. RESULTS: Mean kyphosing effect was 6 +/- 1.4 degrees, induced by the posterior distraction system. This accentuated the initial lumbar hypolordosis related to the degenerative disease. Comparison of the pre- and postoperative films revealed four types of sagittal reaction of the lumbopelvic segment: no modification (type A), significant loss of lordosis without change at the pelvis level (type B) or with compensatory pelvic retroversion (type C), accentuation of the lordosis with pelvic anteversion (type D). CONCLUSION: The dynamic neutralization system (Dynesis) can stabilize degenerative discopathy and protect the adjacent levels. Posterior distraction perturbs the initial hypokyphosis and can lead to pelvic compensation to achieve better dynamic balance. This loss of lordosis is however a cause of excessive mechanical stress on the lumbar structures and can lead to long-term degradation. Future developments of this dynamic system should take into account the essential factor of sagittal balance.

Adult↗
PubMed2005

Unstable slipped capital femoral epiphysis: reduction by gradual distraction with external fixator. A case report.

Severe unstable slipped capital femoral epiphysis (SCFE) usually requires some form of reduction before stabilization to avoid loss of motion and to prevent the development of early degenerative arthritis. Gentle manipulation and traction is being used to achieve reduction. The force applied with these techniques is uncontrolled and unpredictable, and may add to the pre-existing risk of avascular necrosis of the femoral head in such cases. The authors report a case of acute on chronic, severe, unstable SCFE in which reduction was satisfactorily achieved by gradual distraction using an external fixator across the hip joint. The patient did not show signs of avascular necrosis or chondrolysis at a follow-up of 38 months. Hip function was excellent with Iowa hip score of 98 at the final follow-up.

Cartilage, Articular↗
PubMed2004

[Tibial realignment with external fixator].

External fixation is a proved method for high tibial osteotomies. It is easy to access, allows postoperative corrections of the alignment, and can be removed without additional narcosis. Disadvantages are the frequent infection of the pin tracks and discomfort in bearing compared to internal fixation. In our own study no difference between unilateral and bilateral fixation could be found regarding loss of correction and complications. The advantage of unilateral fixation is the possibility of doing an open-wedge procedure by unilateral continuous callus distraction (hemicallotasis). This is indicated if medial collateral instability can be compensated by the open-wedge technique. The occurrence of neural injuries was significantly less frequent after hemicallotasis. Regular radiological and clinical control of the axis is necessary to prevent loss of correction, which was significantly more frequent in open-wedge osteotomies.

Bone Malalignment↗
PubMed2003

Shortening and deformity of radius and ulna in children: correction of axis and length by callus distraction.

Forearm deformities in children and adolescents may be congenital or developmental, or result from trauma; they may cause pain and decreased function of the wrist and hand. In this study we treated seven patients with forearm deformities (10 forearms) by callus distraction of either the radius or ulna using a monolateral external fixator after osteotomy. Target length was achieved in all cases. The results show significant improvement in range of motion of the forearm. All patients were satisfied with the appearance. There were no complications such as pin tract infection or neural impairment. In one case delayed ossification was resolved by alternating distraction and compression. The timing of correction depends on the implications of the deformity for the carpal bones and the function of the other forearm. Monolateral external fixation proved a versatile tool for correction of forearm deformity in children and adolescents, with a low complication rate.

Adolescent↗
PubMed2005

[Effects of different TiNi-SMA distractor on the height of alveolar ridge augmentation].

OBJECTIVE: To discuss the effects of titanium nickel shape memory alloy (TiNi-SMA) distractor with different stretching force and different distance between two fixed ends on the height of alveolar ridge augmentation. METHODS: The mini distractors were all made of TiNi-SMA wire. The maximum stretching force and the distance between two fixed ends according to different distractors (A, B and C) were 20 mm, 700 g; 15 mm, 1000 g; 20 mm, 1000 g. 15 adult mongrel canines were divided into three groups randomly and extracted the mandibular premolars and first molar. One month later, box-shaped osteotomies of the alveolar bone were carried out in the left mandible and the TiNi-SMA distractors were buried. The bone height was measured and the radiographs were taken before and five weeks post operation continuously. RESULTS: One week post operation, the vertical ridge augmentation of group A, B and C averaged (7.55 +/- 1.02) mm, (4.97 +/- 0.34) mm, (8.54 +/- 0.82) mm and the height remained (7.20 +/- 1.05) mm, (4.93 +/- 0.21) mm, (8.04 +/- 0.78) mm five weeks post operation. There was no statistic difference in the height of alveolar ridge augmentation between Group A and C, but Group B showed significant difference with the other two groups. In each group, the height did not changed significantly with the time. The radiographs showed obvious distraction gap post operation, and the new bone regenerated five weeks later. CONCLUSION: It suggests that in the scope of suitable stretching force, the height of alveolar ridge augmentation was determined by the size of TiNi-SMA distractor, that is to say, determined by the distance between the two fixed ends.

Adult↗
PubMed2004

New internal Le Fort I distractor for the treatment of midface hypoplasia.

A new Le Fort I internal distraction device was developed by one of the authors (J. G.) and successfully used on a patient with cleft lip and palate and severe maxillary hypoplasia. The device consisted of an upper plate and a lower plate, which were installed above and below the Le Fort I osteotomy. The upper plate was shaped like a "U," and the lower plate was shaped like an inverted "U." The design of the device was unique in that the distraction screws were placed in the maxillary sinus and orientated parallel to the sagittal plane. Presurgical planning used a stereolithographic (STL) model and the CASSOS software to calculate the distraction vector. The distractors were prebent and installed on the STL model and activated to advance the maxilla 15.5 mm. Surgery was performed in a conventional manner, and distraction was started on the seventh day after surgery. At the completion of distraction, a total of 15.5 mm of distraction was achieved. The distractors were removed 3 months after surgery. Results showed that the patient's severe maxillary hypoplasia was corrected as predicted and there was excellent new bone formation between the edges of the osteotomy.

Adolescent↗
PubMedDate not supplied

The effect of pulsed ultrasound on mandibular distraction.

This study evaluated the effect of pulsed ultrasound on tissue repair and bone growth during mandibular osteodistraction. Twenty-one rabbits were divided into three groups of 7. The distraction started 72 h after surgically severing both sides of the mandible and proceeded at a rate of 1.5 mm/12 h for 5 days. Group I received pulsed ultrasound (nominally 200 micros pulse of 1.5 MHz at a 1.1 kHz pulse repetition frequency, 30 mW/cm2) for 20 min on both sides of the mandible every other day (alternating sides). Group 2 received the same pulsed ultrasound treatment on one side of the mandible every day for 20 min. Group 3 did not receive any ultrasound treatment. Bone formation at the distraction site was assessed by photodensitometry on head radiographs, a vibratory coherence test across the distraction site, a postmortem three-point bending mechanical stiffness test, and a postmortem histological examination. Statistical analyses performed using analysis of variance revealed that pulsed ultrasound enhanced bone formation at the distraction site with a high level of significance when assessed by the increase in new bone photodensity (p = 0.001), vibratory coherence (p = 0.001), mechanical stiffness (p = 0.003), and qualitative histological studies, especially when the pulsed ultrasound treatment was directly applied daily.

Animals↗
PubMed2006

An unusual complication of mandibular distraction.

BACKGROUND: The authors present an unusual complication of mandibular distraction in a child with the curious condition of multiple pterygium syndrome is presented. CASE REPORT: The patient was a Caucasian male with severe pterygia in his neck. As a result of his limited mouth opening and restricted upper airway leading to obstruction, he underwent lengthening of his mandible by distraction, which significantly improved his breathing. During his follow-up, it was observed that an unusually elongated permanent molar was present in an abnormal position. CONCLUSION: This case highlights the need to carefully plan the sites for osteotomy and the potential for damage to the developing permanent dentition in young children.

Child, Preschool↗
PubMed2002

Osteodistraction of a previously irradiated mandible with or without adjunctive hyperbaric oxygenation: an experimental study in rabbits.

The purpose of this study was to analyse the effects of irradiation and hyperbaric oxygenation (HBO) on mandibular osteodistraction (OD). Eighteen rabbits were divided into three groups: 1. Irradiation (R), 2. Irradiation+HBO (R-HO), and 3. Control group (C). Animals of groups R and R-HO received in the mandible irradiation 22.4 Gy in four 5.6 Gy fractions (equivalent to 50 Gy/25 fractions). In addition, group R-HO was given HBO at 2.5 ATA for 90 min per day 18 times preoperatively. Unilateral osteotomy was made 1 month after completion of radiotherapy. After a 1 week latency period bone distraction was started at rate of 1 mm per day, continued for 2 weeks, and left to consolidate for 4 weeks. Amount of new bone was measured histomorphometrically from midsagittal sections. Area of new bone was equal in all groups. Bone was more mature and bone spicules better organized in group C than in groups R and R-HO. Cartilaginous cells were found in distracted bone in all groups but larger chondroid islands were evident only in group R. It seems that despite delayed bone formation, OD can be performed after radiotherapy. HBO had a beneficial effect on bone quality of a previously irradiated mandible.

Animals↗
PubMed2006

Vertical mandibular alveolar bone distraction and dental implant placement: a case report.

Extensive bone defects complicate the adequate placement of dental implants and the required angulation. In such cases, alveolar-ridge augmentation techniques such as guided bone regeneration, particulate or block grafting, and alveolar bone distraction are needed. The present study describes a case in which a large vertical bone defect in the anterior mandibular zone was corrected via vertical alveolar bone distraction. Six dental implants were posteriorly placed for implant-supported restoration of the mandible, with early implant loading. The clinical and radiologic control showed good implant and soft tissue conditions 12 months later.

Adult↗
PubMed1996

Microvascular soft-tissue coverage and distraction osteosynthesis for lower-extremity salvage.

In our attempts to salvage massive lower-extremity injuries, even in the presence of severe peripheral vascular pathology, adequate soft-tissue coverage is no longer a limiting factor due to recent advances in microvascular composite tissue transfer. Restoration of tibial continuity without shortening has emerged as the last obstacle in the formidable task of salvaging lower extremities with grade III B and III C defects. Proposed solutions to this problem include conventional free cancellous bone-grafting applicable to small defects only, vascularized bone grafts, or shortening of the leg with subsequent elongation using the Ilizarov technique. We present our experience with 3 consecutive cases of lower-limb salvage, utilizing a new approach in which microsurgical soft-tissue reconstruction has been combined with bony reconstruction by distraction osteosynthesis. Bone transport by distraction osteosynthesis under a free flap performed while preserving the initial limb length throughout the treatment period proved to be superior to other methods in selected cases and is presented as a new technique for the management of problematic lower-limb injuries.

Adolescent↗
PubMed2005

Anterior transmandibular osteodistraction: clinical and model observations.

INTRODUCTION: The aim of this paper was to study the effect of transmandibular distraction on the periodontal and dental structures, and the initial movements of the mandibular halves, when using an axial plane non-rigid bone-borne distractor (TMD). MATERIAL AND METHODS: Fourteen patients undergoing bimaxillary transverse osteodistraction had their six lower anterior teeth assessed for mobility, sensitivity, and pocket depth. Recordings were made pre-operatively, post-distraction, post-consolidation and at 1-year follow-up. Selected landmarks on pre-operative and post-consolidation models were also digitised in three dimensions to study individual tooth movements, and positional changes of the mandibular halves. RESULTS: Pockets depths around the incisor teeth increased during the consolidation period (probably due to reduced oral hygiene), but returned to normal by the 1-year post-operative consultation. Tooth mobility increased temporarily in the active phase (central incisors, lateral incisors) and in the consolidation phase (lateral incisors, canine teeth). Sensitivity to cold was temporarily lost in the incisor teeth, probably as a result of 'apical contusion'. One central incisor was inadvertently apically osteotomized and needed root canal treatment. The angle between the mandibular halves closed by 9.4 degrees. CONCLUSION: Periodontal and dental morbidity is transient and limited to the distraction and consolidation period, as long as the tooth apices are avoided when the osteotomy is performed. A step-design osteotomy may be preferable when the central incisor apices are close to each other. The transmandibular distractor (TMD) allows for rotation at the temporomandibular joints.

Adolescent↗
PubMed2003

Validation of in vivo assessment of facial soft-tissue volume changes and clinical application in midfacial distraction: a technical report.

The purpose of this study was to validate the assessment of visible volume changes of the facial soft tissue with an optical three-dimensional sensor and to introduce new parameters for the evaluation of the soft-tissue shape achieved from three-dimensional data of selected cases of midfacial distraction. Images of a truncated cone of known volume were assessed repeatedly with an optical three-dimensional sensor based on phase-measuring triangulation to calculate the volume. Two cubic centimeters of anesthetic solution was injected into the right malar region of 10 volunteers who gave their informed consent. Three-dimensional images were assessed before and immediately after the injections for the assessment of the visible volume change. In five patients who underwent midfacial distraction after a high quadrangular Le Fort I osteotomy, three-dimensional scans were acquired before and 6 and 24 months after the operation. The visible soft-tissue volume change in the malar-midfacial area and the mean distance of the accommodation vector that transformed the preoperative into the postoperative surface were calculated. The volume of the truncated cone was 235.26 +/- 1.01 cc, revealing a measurement uncertainty of 0.4 percent. The injections of anesthetic solution into the malar area resulted in an average visible volume change of 2.06 +/- 0.06 cc. The measurement uncertainty was 3 percent. In the five patients, the average distance of maxillary advancement was 6.7 +/- 2.3 mm after 6 months and 5.4 +/- 3.0 mm after 2 years. It was accompanied by a mean visible volume increase of 8.92 +/- 5.95 cc on the right side and 9.54 +/- 4.39 cc on the left side after 6 months and 3.54 +/- 3.70 cc and 4.80 +/- 3.47 cc, respectively, after 2 years. The mean distance of the accommodation vector was 4.41 +/- 1.94 mm on the right side and 4.74 +/- 1.32 mm on the left side after 6 months and 1.62 +/- 1.96 mm and 2.16 +/- 1.52 mm, respectively, after 2 years. The assessment of visible volume changes by optical three-dimensional images can be carried out with considerable accuracy. The determination of volume changes and accompanying accommodation vectors completes the cephalometric analysis during the follow-up of patients undergoing midfacial distraction. The new parameters will help to assess normative soft-tissue data on the basis of three-dimensional imaging with a view to an improved three-dimensional prediction of the operative outcome of orthognathic surgery.

Adolescent↗