eMedicine Specialties > Plastic Surgery > Craniofacial

Craniofacial, Distraction Osteogenesis: Follow-up

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

Outcome and Prognosis

With increasing clinical experience, the long-term outcome and the specific role of distraction osteogenesis are better defined today. Clearly, distraction can generate bone with the capacity for remodeling and adaptation to functional loads. However, distraction osteogenesis is likely incapable of restoring the normal development of a once dysplastic pattern of craniofacial growth. Distraction techniques allow the surgeon to intervene earlier in childhood to restore the facial form and function, but the extent to which it eliminates subsequent conventional procedures remains uncertain.

Typical airway changes after mandibular distracti...

Typical airway changes after mandibular distraction.

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Typical airway changes after mandibular distracti...

Typical airway changes after mandibular distraction.


Future and Controversies

As with conventional orthognathic surgery, distraction osteogenesis of the craniofacial skeleton should be considered one of the many tools in the armamentarium of a surgeon. Compared to orthopedic lengthening and rotations of long bones, craniofacial distraction is highly complex. Challenges include carefully placed osteotomies to mobilize facial elements and the multidirectional vectors of distraction. The last 5 years have seen exciting advances in computer-assisted surgery. Newly designed software can simulate osteotomies and planned distraction in difficult, asymmetric cases. Cone beam CT scanners, which provide excellent bony resolution at a fraction of the radiation, are now available for intraoperative CT imaging and postoperative follow-up.
 
The extent to which distraction osteogenesis will replace conventional approaches depends largely on technical innovations that will allow for implantable multidirectional devices that can be easily activated and controlled remotely with minimal incisions.

 


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
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References

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Further Reading

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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

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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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