eMedicine Specialties > Plastic Surgery > Craniofacial
Craniofacial, Distraction Osteogenesis: Workup
Updated: Jun 30, 2009
Workup
Imaging Studies
The workup primarily relies on radiographic information to define the anatomic deformity and to assess whether distraction osteogenesis is a viable alternative to the conventional surgery. Routine radiographic studies typically include CT with 3-dimensional reconstructions and dental radiographs (Panorex, frontal, and lateral cephalometric films). These studies serve to give a 3-D representation of the craniofacial abnormality and to determine whether sufficient bony stock is present for device fixation.7
CT imaging illustrating skeletal deformity and airway compromise in infant with Pierre Robin sequence.
Other Tests
Children with complex deformities require a multidisciplinary approach to reconstruction. All patients should be seen shortly before the procedure by a pediatrician. Secondly, close cooperation is necessary among plastic surgeons, oral surgeons, orthodontists, and pediatric dentists.
Neonates and infants with obstructive apnea may require flexible nasoendoscopy and polysomnography for diagnosis confirmation.6 Failed nonsurgical upper airway stabilization measures like prone positioning, chest rolls, and nasopharyngeal tubes, should be documented.
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References
Ilizarov GA. The Transosseous Osteosynthesis: Theoretical and Clinical Aspects of the Regeneration and Growth of Tissue. New York: Springer-Verlag;1992.
McCarthy JG, Schreiber J, Karp N. Lengthening the human mandible by gradual distraction. Plast Reconstr Surg. Jan 1992;89(1):1-8; discussion 9-10. [Medline].
Steinberg B, Fattahi T. Distraction osteogenesis in management of pediatric airway: evidence to support its use. J Oral Maxillofac Surg. Aug 2005;63(8):1206-8. [Medline].
Denny AD. Distraction osteogenesis in Pierre Robin neonates with airway obstruction. Clin Plast Surg. Apr 2004;31(2):221-9. [Medline].
Fritz MA, Sidman JD. Distraction osteogenesis of the mandible. Curr Opin Otolaryngol Head Neck Surg. Dec 2004;12(6):513-8. [Medline].
Li HY, Lee LA. Sleep-disordered Breathing in Children. Chang Gung Med J. May-Jun 2009;32(3):247-57. [Medline].
Kaban LB, Seldin EB, Kikinis R, Yeshwant K, Padwa BL, Troulis MJ. Clinical application of curvilinear distraction osteogenesis for correction of mandibular deformities. J Oral Maxillofac Surg. May 2009;67(5):996-1008. [Medline].
Polley JW, Figueroa AA. Management of severe maxillary deficiency in childhood and adolescence through distraction osteogenesis with an external, adjustable, rigid distraction device. J Craniofac Surg. May 1997;8(3):181-5; discussion 186. [Medline].
Chin M, Toth BA. Le Fort III advancement with gradual distraction using internal devices. Plast Reconstr Surg. Sep 1997;100(4):819-30; discussion 831-2. [Medline].
Nada RM, Sugar AW, Wijdeveld MG, et al. Current practice of distraction osteogenesis for craniofacial anomalies in Europe: A web based survey. J Craniomaxillofac Surg. May 15 2009;[Medline].
Cohen SR, Boydston W, Burstein FD. Monobloc distraction osteogenesis during infancy: report of a case and presentation of a new device. Plast Reconstr Surg. Jun 1998;101(7):1919-24. [Medline].
Figueroa AA, Polley JW, Friede H, Ko EW. Long-term skeletal stability after maxillary advancement with distraction osteogenesis using a rigid external distraction device in cleft maxillary deformities. Plast Reconstr Surg. Nov 2004;114(6):1382-92; discussion 1393-4. [Medline].
Grubb J, Smith T. Practical applications of distraction osteogenesis. Am J Orthod Dentofacial Orthop. Sep 2004;126(3):271-2. [Medline].
McCarthy JG. Distraction of the Craniofacial Skeleton. New York: Springer-Verlag; 1999.
Menezes RD, Zhao L, Patel PK, Modi V. Volumetric changes in the oropharyngeal airway following bilateral mandibular distraction osteogenesis in Pierre Robin Sequence. J Craniofac Surg. Article submitted July 2008.
Mikhail L, Samchukov JB, Cope A. Craniofacial Distraction Osteogenesis. CV Mosby; 2001.
Molina F, Ortiz Monasterio F. Mandibular elongation and remodeling by distraction: a farewell to major osteotomies. Plast Reconstr Surg. Sep 1995;96(4):825-40; discussion 841-2. [Medline].
Wan DC, Nacamuli RP, Longaker MT. Craniofacial bone tissue engineering. Dent Clin North Am. Apr 2006;50(2):175-90, vii. [Medline].
Further Reading
Keywords
distraction osteogenesis, bone lengthening, de novo bone formation, osteotomized bone segments, maxillary deformity, osteogenesis, mandible distraction, craniofacial deformity, hemifacial microsomia, mandibular hypoplasia, tracheostomy, neonatal distraction, pierre robin, Pierre Robin, hypoplastic mandible, mandible surgery, facial surgery, pediatric facial surgery, midfacial deformity, dentofacial deformity, deficient alveolar ridge, orbitofrontal advancement


Workup: Craniofacial, Distraction Osteogenesis