Distraction Osteogenesis Workup

  • Author: Pravin K Patel, MD; Chief Editor: Jorge I de la Torre, MD, FACS   more...
 
Updated: Feb 2, 2012
 

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.[8] See the image below.

CT imaging illustrating skeletal deformity and airCT imaging illustrating skeletal deformity and airway compromise in infant with Pierre Robin sequence.
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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.[7] Failed nonsurgical upper airway stabilization measures like prone positioning, chest rolls, and nasopharyngeal tubes, should be documented.

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Contributor Information and Disclosures
Author

Pravin K Patel, MD  Associate Professor of Surgery, Division of Plastic Surgery, Northwestern University, The Feinberg School of Medicine; Chief of Plastic and Craniofacial Surgery, Shriner's 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  Research Specialist and Craniofacial Fellow, Shriners Hospitals for Children, Chicago; Visiting Research Specialist in Biomedical Engineering, Department of Surgery, University of Illinois at Chicago; Adjunct Assistant Professor, Bioengineering Department, University of Illinois at Chicago; Adjunt Assistant Professor, Biomedical Department, Marquette University

Linping Zhao, PhD is a member of the following medical societies: American Cleft Palate/Craniofacial Association and American Society of Mechanical Engineers

Disclosure: Nothing to disclose.

Specialty Editor Board

John Arthur Persing  MD, Chief and Professor, Department of Surgery, Sections of Plastic Surgery and Neurosurgery, Yale University School of Medicine

John Arthur Persing 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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

R Edward Newsome, MD†  Former Program Director and Chief of Plastic Surgery, Henderson Chair in Surgery, Former 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.

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, Chief, Division of Plastic Surgery, Residency Program Director, University of Alabama at Birmingham School of Medicine; 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.

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. Hong P, Brake MK, Cavanagh JP, Bezuhly M, Magit AE. Feeding and mandibular distraction osteogenesis in children with Pierre Robin sequence: A case series of functional outcomes. Int J Pediatr Otorhinolaryngol. Jan 12 2012;[Medline].

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

  8. 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].

  9. 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].

  10. Yamauchi K, Takahashi T, Nogami S, Kataoka Y, Miyamoto I, Funaki K. Horizontal alveolar distraction osteogenesis for dental implant: long-term results. Clin Oral Implants Res. Jan 26 2012;[Medline].

  11. 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].

  12. 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].

  13. 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].

  14. 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].

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

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

  17. 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.

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

  19. 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].

  20. Wan DC, Nacamuli RP, Longaker MT. Craniofacial bone tissue engineering. Dent Clin North Am. Apr 2006;50(2):175-90, vii. [Medline].

 
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Infant with Pierre Robin sequence.
CT imaging illustrating skeletal deformity and airway compromise in infant with Pierre Robin sequence.
Presurgical planning to determine the distraction vector and osteotomies.
Intraoperative photographs of distractor placement.
Typical airway changes after mandibular distraction.
 
 
 
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