Complications in bilateral mandibular distraction osteogenesis using internal devices (original) (raw)

Stability after distraction osteogenesis to lengthen the mandible: results in 50 patients

Journal of Oral and Maxillofacial Surgery, 2004

The purpose of this study was to investigate mandibular stability after lengthening the mandible by means of distraction. Materials and Methods: Fifty patients (mean age, 14.7 years; range, 11.2 to 37.3 years) with Angle Class II mandibular hypoplasia were treated by bilateral distraction osteogenesis to lengthen the mandible. Patients were divided into a high-angle group, with a high mandibular angle (sella/nasionmandibular plane [SN-MP] Ͼ38°), and a normal-to-low mandibular angle group (SN-MP Յ38°). Clinical measurements and standardized cephalometric radiographs were taken just before operation; postdistraction at time of removal of the distraction devices, and 6 months and 1 year postoperatively. Analysis was performed by means of angle measurements: sella/nasion-maxilla point A (SNA), sella/nasionmandibular point B (SNB), and SN-MP. Results: Eight of 14 high-angle patients showed a degree of relapse (57%), and only 3 of 36 patients showed relapse in the low/normal-angle group (8.3%). Conclusion: It can be concluded that high-angle patients are still at risk of relapsing and that distraction osteogenesis cannot prevent relapse in cases with a high mandibular plane angle. For low-angle patients, however, distraction is a safe and predictable procedure.

Mandibular Osteotomies and Distraction Osteogenesis

JAMA Facial Plastic Surgery, 2013

Importance: Although a number of mandibular and occlusal problems may be addressed by orthodontic treatment alone, dentofacial osteotomies are often needed to achieve desired functional or cosmetic results. With the increased popularity of mandibular distraction osteogenesis in recent years, the role of the facial plastic and reconstructive surgeon is crucial in the multidisciplinary care of patients with such problems.

Mandibular Distraction Osteogenesis A systematic review of literature

—Bone Mandibular Distraction (BMD) is a surgical procedure for the gradual elongation of the bone tissue. Currently, the acquired BMD boom to be an effective treatment that provides a better quality of life for the patient. The region where this method is applied, craniofacial area-specifically in the mandibular region. The BMD is the gradual lengthening of the mandible through their cortical osteotomy. The BMD itself consists of three periods: 1) Latency period. It is determined by the time that is expected to start the distraction. It begins a slow and steady pace. 2) Period of distraction. During this phase, the bone segments are separated by small increments. This stage takes place at a slow, steady rate and is obtained as a result of the new bone formation at the osteotomy site. 3) Period of consolidation. It occurs when the bone segments are carried forward end position. The duration of this period is 4-8 weeks. Finally, the distractor is removed. This technique provides excellent results in the treatment of patients with mandibular development problems.

Intraoral mandibular distraction osteogenesis: special attention to treatment planning

Journal of Cranio-maxillofacial Surgery, 2001

Purpose: To demonstrate our experience using internal devices for unidirectional distraction osteogenesis in treating different mandibular hypoplasias (with or without maxillary deformities). An algorithmic table for diagnosis, and treatment planning is presented. Patients and methods: Twenty internal distraction devices were used in 16 patients with mandibular hypoplasia. Deficiency in length of the mandible was calculated on threedimensional computed tomography scans. The device was activated by a transcutaneous pin on the fifth postoperative day. Distraction was achieved at rates of 0.5 mm/12 h. After a variable period of consolidation the devices were removed. Mean follow-up was 18 months. Results: Successful distraction osteogenesis was achieved in all patients. No premature consolidation or pseudoarthrosis was observed. Improvement of facial aesthetics was produced in all cases. Final occlusion was excellent in those cases where no simultaneous maxillary deformity was present. Orthodontic treatment was applied in all cases. Results remained stable one year postoperatively. Conclusions: The occlusal results obtained in this series show that we can plan distraction as a definitive treatment in cases with isolated mandibular hypoplasia. When an additional maxillary deformity is present, mandibular distraction must be performed first if indicated, but a maxillary procedure will be necessary later. # 2001 European Association for Cranio-Maxillofacial Surgery

Mandibular Deformity Correction by Distraction Osteogenesis

Bangabandhu Sheikh Mujib Medical University Journal, 2011

Distraction osteogenesis (DO) is a biological process of new bone formation between the surfaces of bone segments that are gradually separated by incremental traction 1. A callus forms between the separated bone segments and as long as the traction proceeds, callus tissues are stretched inducing the new bone formation 2. DO was first introduced by Codivilla at the beginning of twentieth century and during 1950s. Modern distraction osteogenesis evolved primarily from the work of Gavriel llizarov. The studies of Ilizarov made a contribution in the development of the technique by elucidation the biological and mechanical principals in the formation of new bone 3-4. DO has been first applied to craniofacial region since McCarthy et al. In the lengthening of the hypoplastic mandible, external or intraoral devices have been used. Extra oral distraction device fixes extra orally so are not convenient socially and leave residual skin scars but intraoral distraction device are more convenient socially and leave no residual skin scars. In this case report, we intended to present the treatment of a 17 years old male who had severe mandibular deficiency. An intra-oral distractor was used to achieve independent horizontal distraction of the mandibular body. Amount of lengthening was determined by models and lateral cephalometry analysis.

Distraction osteogenesis for reconstruction after mandibular segmental resection

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 2002

Distraction osteogenesis of the mandible is a promising method, not only for correcting mandibular hypoplasiasuch as hemifacial microsomia 1 -but also for reconstructing the bone defect after segmental resection of the mandible. The bone transport technique and compression osteogenesis have been used for mandibular reconstruction in gunshot defects 3 and resected bone defects. Distraction osteogenesis with the shortening and lengthening method, or resective distraction osteogenesis, is a new approach to treat segmental diaphysial bone defects by initial limb shortening with secondary distraction osteogenesis from the same site. 4 Meffert et al 5 demonstrated that the bone regeneration characteristics of this technique are not different from those of simple lengthening procedures. Although this method is well established for repairing extremities, there is, to our knowledge, no report of its use for mandibular segmental bone defects. This method seems to be clinically useful because there is no need to transport bone and no scar formation of the skin by the use of the extraoral devices. Here we report a case in which this method was applied for reconstruction after segmental resection of the mandible.

Distraction osteogenesis for correcting maxillo-mandibular deformities

Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2012

OBJECTIVE To determine the effectiveness of distraction osteogenesis (DO) for correcting maxillofacial deformities. STUDY DESIGN Case series. PLACE AND DURATION OF STUDY Department of Oral and Maxillofacial Surgery, Armed Forces Institute of Dentistry, Rawalpindi, from June 2008 to November 2010. METHODOLOGY Patients with diverse maxillofacial deformities were selected for the study. In all cases, intraoral distractors were used. Mandibular osteotomies were done using submandibular incision and maxillary osteotomy was done using standard vestibular incision. In paediatric patients, DO was started on third postoperative day while in adults, a 7-day latency period was followed. Distraction was carried out at a rate of 0.5 mm twice daily (1 mm/day). Distractors were removed after a consolidation period of 2 months. RESULTS A total 7 cases were operated for DO. Out of these, 3 were males and 4 females. The age ranged from 2-24 years (mean 12.57 + 9.48 years). Five patients had their def...