eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Craniofacial Surgery

Craniofacial Distraction Osteogenesis: Follow-up

Author: Mario J Imola, MD, DDS, FRCSC, FACS, Consulting Staff, Department of Otolaryngology-Head & Neck Surgery, Center for Craniofacial and Skull Base Surgery
Contributor Information and Disclosures

Updated: Jun 30, 2009

Outcome and Prognosis

Distraction osteogenesis (DO) holds great potential for various osseous defects that can be encountered within the craniofacial skeleton.8 Numerous advantages seem to be emerging with the technique. The initial osteotomy procedure is less invasive and does not carry the attendant limitations and complications that may be associated with conventional bony mobilization and repositioning. Furthermore, the potential for substantially larger movements and greater postoperative stability exists. Surgical intervention is possible in the very young patient and, apparently, much earlier than with standard craniofacial technique.

DO, however, does not correct underlying growth disturbances in craniofacial patients. DO does not reduce the need for orthodontic intervention, and it carries the disadvantage of requiring a second procedure to remove the distraction appliances. As experience with DO accumulates, this technique is becoming established as an essential tool in the craniofacial surgeon's armamentarium. The indications in which it is the standard of care are slowly being defined.

Future and Controversies

Several new developments are on the horizon in the field of craniofacial DO. A successful combination of endoscopic techniques to create osteotomies and insert distraction devices will move distraction into the field of minimally invasive surgery. New work using bioresorbable materials may lead to the implementation of devices that do not require a second surgical procedure to remove them and following resorption leave no trace that they had ever been inserted. In addition, use of microprocessors and miniature motorized distraction devices may provide the ability to insert submerged appliances capable of auto-distraction according to preprogrammed data.

 


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
Further Reading
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References

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  2. Costantino PD, Friedman CD, Shindo ML, et al. Experimental mandibular regrowth by distraction osteogenesis. Long-term results. Arch Otolaryngol Head Neck Surg. May 1993;119(5):511-6. [Medline].

  3. McCarthy JG, Schreiber J, Karp N, et al. Lengthening the human mandible by gradual distraction. Plast Reconstr Surg. Jan 1992;89(1):1-8; discussion 9-10. [Medline].

  4. Tibesar RJ, Sidman JD. Mandibular distraction osteogenesis in the pediatric patient. Curr Opin Otolaryngol Head Neck Surg. Dec 2008;16(6):548-54. [Medline].

  5. Higuera S, Cole P, Stephenson JB, Hollier L. Distraction rate and latency: factors in the outcome of paediatric maxillary distraction. J Plast Reconstr Aesthet Surg. Nov 5 2008;[Medline].

  6. Reddy LV, Elhadi HM. Maxillary advancement by distraction osteogenesis. Atlas Oral Maxillofac Surg Clin North Am. Sep 2008;16(2):237-47. [Medline].

  7. Dauria D, Marsh JL. Mandibular distraction osteogenesis for Pierre Robin sequence: what percentage of neonates need it?. J Craniofac Surg. Sep 2008;19(5):1237-43. [Medline].

  8. Al-Daghreer S, Flores-Mir C, El-Bialy T. Long-term stability after craniofacial distraction osteogenesis. J Oral Maxillofac Surg. Sep 2008;66(9):1812-9. [Medline].

  9. [Guideline] Persing J, James H, Swanson J, Kattwinkel J. Prevention and management of positional skull deformities in infants. American Academy of Pediatrics Committee on Practice and Ambulatory Medicine, Section on Plastic Surgery and Section on Neurological Surgery. Pediatrics. Jul 2003;112(1 Pt 1):199-202. [Medline].

  10. Cohen SR, Rutrick RE, Burstein FD. Distraction osteogenesis of the human craniofacial skeleton: initial experience with new distraction system. J Craniofac Surg. Sep 1995;6(5):368-74. [Medline].

  11. Imola MJ. Craniofacial distraction osteogenesis. Current Opin Otolaryngol Head Neck Surg. 2001;9:238-248.

  12. Imola MJ, Hamlar DD, Thatcher G, et al. The versatility of distraction osteogenesis in craniofacial surgery. Arch Facial Plast Surg. Jan-Mar 2002;4(1):8-19. [Medline].

  13. Molina F, Ortiz Monasterio F. Mandibular elongation and remodeling by distraction: a farewell to majorosteotomies. Plast Reconstr Surg. Sep 1995;96(4):825-40; discussion 841-2. [Medline].

  14. Toth BA, Kim JW, Chin M, Cedars M. Distraction osteogenesis and its application to the midface and bony orbit in craniosynostosis syndromes. J Craniofac Surg. Mar 1998;9(2):100-13; discussion 119-22. [Medline].

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Keywords

craniofacial distraction osteogenesis, distraction osteogenesis, craniofacial DO, DO, bone distraction, craniofacial deformities

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Contributor Information and Disclosures

Author

Mario J Imola, MD, DDS, FRCSC, FACS, Consulting Staff, Department of Otolaryngology-Head & Neck Surgery, Center for Craniofacial and Skull Base Surgery
Mario J Imola, MD, DDS, FRCSC, FACS is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Cleft Palate/Craniofacial Association, American Head and Neck Society, American Laryngological Rhinological and Otological Society, American Medical Association, AO Foundation, Canadian Academy of Facial Plastic and Reconstructive Surgery, Canadian Society of Otolaryngology-Head & Neck Surgery, College of Physicians and Surgeons of Ontario, Colorado Medical Society, and North American Skull Base Society
Disclosure: Nothing to disclose.

Medical Editor

Jaime R Garza, MD, DDS, FACS, Consulting Staff, Private Practice
Jaime R Garza, MD, DDS, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Medical Association, American Society for Aesthetic Plastic Surgery, American Society of Maxillofacial Surgeons, Texas Medical Association, and Texas Society of Plastic Surgeons
Disclosure: Allergan Honoraria Consulting

Pharmacy Editor

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

Managing Editor

David W Stepnick, MD, Associate Professor, Departments of Plastic Surgery and Otolaryngology-Head and Neck Surgery, Case Western Reserve University School of Medicine, University Hospitals of Cleveland Case Medical Center
David W Stepnick, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society for Head and Neck Surgery, and Society of University Otolaryngologists-Head and Neck Surgeons
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo  Consulting; Medvoy Ownership interest Management position

 
 
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