Craniofacial Distraction Osteogenesis Workup

  • Author: Mario J Imola, MD, DDS, FRCS, FACS, FRCS(C); Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Apr 13, 2012
 

Imaging Studies

The workup for patients under consideration for craniofacial distraction can include several imaging studies. All patients require careful clinical assessment and photographic documentation of their condition. Frontal and lateral cephalograms and a mandibular Panorex view are obtained in virtually all patients. Three-dimensional CT scanning is also useful. Stereolithographic acrylic models provide a life-size 3-dimensional reproduction of the facial skeleton and are the ultimate method to study the deformity. Their cost and limited availability presently constrain widespread use.

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Contributor Information and Disclosures
Author

Mario J Imola, MD, DDS, FRCS, FACS, FRCS(C)  Consulting Staff, Department of Otolaryngology-Head and Neck Surgery, Center for Craniofacial and Skull Base Surgery, Colorado Facial Plastic Surgery

Mario J Imola, MD, DDS, FRCS, FACS, FRCS(C) 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.

Specialty Editor Board

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 College of Surgeons, American Society for Aesthetic Plastic Surgery, American Society of Maxillofacial Surgeons, Texas Medical Association, and Texas Society of Plastic Surgeons

Disclosure: Allergan None Speaking and teaching; LifeCell None Consulting; GID, Inc. Grant/research funds Other

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

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.

Christopher L Slack, MD  Private Practice in Otolaryngology and Facial Plastic Surgery, 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 of Otolaryngology, Dentistry, and Engineering, 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 Unrestricted gift Unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Medvoy Ownership interest Management position; Cerescan Imaging Consulting; Headwatersmb Consulting fee Consulting; Venturequest Royalty Consulting

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. Taylor JA, Derderian CA, Bartlett SP, Fiadjoe JE, Sussman EM, Stricker PA. Perioperative Morbidity in Posterior Cranial Vault Expansion: Distraction Osteogenesis versus Conventional Osteotomy. Plast Reconstr Surg. Apr 2012;129(4):674e-80e. [Medline].

  4. 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].

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  12. [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].

  13. 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].

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

  15. 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].

  16. 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].

  17. 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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Intraoperative photographs of distractor placement.
Typical airway changes after mandibular distraction.
 
 
 
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