eMedicine Specialties > Plastic Surgery > Craniofacial

Craniofacial, Distraction Osteogenesis: Workup

Author: Pravin K Patel, MD, Associate Professor of Surgery, Division of Plastic Surgery, Northwestern University School of Medicine; Chief of Plastic and Craniofacial Surgery, Shriners Hospitals for Children; Head of Craniofacial Surgery, Children's Memorial Hospital
Coauthor(s): Marco F Ellis, MD, Resident Physician, Department of Plastic and Reconstructive Surgery, Northwestern Memorial Hospital; Linping Zhao, PhD, MSE, Research Specialist and Craniofacial Fellow, Shriners Hospitals for Children, Chicago; Visiting Research Specialist in Biomedical Engineering, Department of Surgery, University of Illinois Medical Center; Adjunct Assistant Professor, Bioengineering Department, University of Illinois at Chicago
Contributor Information and Disclosures

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 ai...

CT imaging illustrating skeletal deformity and airway compromise in infant with Pierre Robin sequence.

CT imaging illustrating skeletal deformity and ai...

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.

More on Craniofacial, Distraction Osteogenesis

Overview: Craniofacial, Distraction Osteogenesis
Workup: Craniofacial, Distraction Osteogenesis
Treatment: Craniofacial, Distraction Osteogenesis
Follow-up: Craniofacial, Distraction Osteogenesis
Multimedia: Craniofacial, Distraction Osteogenesis
References

References

  1. Ilizarov GA. The Transosseous Osteosynthesis: Theoretical and Clinical Aspects of the Regeneration and Growth of Tissue. New York: Springer-Verlag;1992.

  2. 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].

  3. 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].

  4. Denny AD. Distraction osteogenesis in Pierre Robin neonates with airway obstruction. Clin Plast Surg. Apr 2004;31(2):221-9. [Medline].

  5. Fritz MA, Sidman JD. Distraction osteogenesis of the mandible. Curr Opin Otolaryngol Head Neck Surg. Dec 2004;12(6):513-8. [Medline].

  6. Li HY, Lee LA. Sleep-disordered Breathing in Children. Chang Gung Med J. May-Jun 2009;32(3):247-57. [Medline].

  7. 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].

  8. 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].

  9. 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].

  10. 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].

  11. 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].

  12. 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].

  13. Grubb J, Smith T. Practical applications of distraction osteogenesis. Am J Orthod Dentofacial Orthop. Sep 2004;126(3):271-2. [Medline].

  14. McCarthy JG. Distraction of the Craniofacial Skeleton. New York: Springer-Verlag; 1999.

  15. 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.

  16. Mikhail L, Samchukov JB, Cope A. Craniofacial Distraction Osteogenesis. CV Mosby; 2001.

  17. 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].

  18. 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

Contributor Information and Disclosures

Author

Pravin K Patel, MD, Associate Professor of Surgery, Division of Plastic Surgery, Northwestern University School of Medicine; Chief of Plastic and Craniofacial Surgery, Shriners Hospitals for Children; Head of Craniofacial Surgery, Children's Memorial Hospital
Disclosure: Nothing to disclose.

Coauthor(s)

Marco F Ellis, MD, Resident Physician, Department of Plastic and Reconstructive Surgery, Northwestern Memorial Hospital
Marco F Ellis, MD is a member of the following medical societies: American College of Surgeons and American Society of Plastic Surgeons
Disclosure: Nothing to disclose.

Linping Zhao, PhD, MSE, Research Specialist and Craniofacial Fellow, Shriners Hospitals for Children, Chicago; Visiting Research Specialist in Biomedical Engineering, Department of Surgery, University of Illinois Medical Center; Adjunct Assistant Professor, Bioengineering Department, University of Illinois at Chicago
Linping Zhao, PhD, MSE is a member of the following medical societies: American Cleft Palate/Craniofacial Association and American Society of Mechanical Engineers
Disclosure: Nothing to disclose.

Medical Editor

John Persing, MD, Chief, Professor, Department of Surgery, Sections of Plastic Surgery and Neurosurgery, Yale University School of Medicine
John Persing, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Neurological Surgeons, American Association of Plastic Surgeons, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Medical Association, American Society of Maxillofacial Surgeons, New York Academy of Sciences, and Society for Neuroscience
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

R Edward Newsome, MD, Program Director and Chief of Plastic Surgery, Henderson Chair in Surgery, Assistant Dean for Graduate Medical Education, Tulane University School of Medicine
R Edward Newsome, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Society of Plastic and Reconstructive Surgery, American Society of Plastic Surgeons, and Louisiana State Medical Society
Disclosure: Nothing to disclose.

CME Editor

Nicolas (Nick) G Slenkovich, MD, Director, Colorado Plastic Surgery Center
Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society of Aesthetic Plastic Surgery, American Society of Plastic Surgeons, and Colorado Medical Society
Disclosure: Nothing to disclose.

Chief Editor

Jorge I de la Torre, MD, FACS, Professor of Surgery and Physical Medicine and Rehabilitation, Residency Program Director, Division of Plastic Surgery, University of Alabama at Birmingham; Director, Center for Advanced Surgical Aesthetics
Jorge I de la Torre, MD, FACS is a member of the following medical societies: American Association of Plastic Surgeons, American Burn Association, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Society for Reconstructive Microsurgery, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Association for Academic Surgery, and Medical Association of the State of Alabama
Disclosure: Nothing to disclose.

 
 
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