Distraction Osteogenesis of the Maxilla Workup

  • Author: Anil R Shah, MD; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Apr 17, 2012
 

Imaging Studies

Patients undergoing distraction require a photographic assessment throughout the distraction to assess their progress.

  • Necessary radiographic studies include cephalography, mandibular panoramic (Panorex) imaging, and CT.
  • Not all surgeons recommend 3-dimensional reconstructive scanning.

Several important relationships must be considered before distraction of the mid face is preformed.

  • Quantifying the degree of exorbitism is especially important in syndromic patients.
  • Important relationships include the maxillary plane and the occlusal plane angle.
  • Assessing the anteroposterior deficiency in the mid face in relation to the remaining facial structures is also important.
Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Anil R Shah, MD  Plastic Surgeon, Private Practice

Anil R Shah, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, and Triological Society

Disclosure: Nothing to disclose.

Coauthor(s)

Daniel G Danahey, MD, PhD  Consulting Staff, Department of Otolaryngology, DuPage Medical Group

Daniel G Danahey, MD, PhD 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, American Cleft Palate/Craniofacial Association, and Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

Mimi S Kokoska, MD  Associate Professor, Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences; Chief, Department of Otolaryngology-Head and Neck Surgery, Central Arkansas Veterans Healthcare System

Mimi S Kokoska, 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 Physician Executives, American College of Surgeons, American Head and Neck Society, and Arkansas Medical Society

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

Robert M Kellman, MD  Professor and Chair, Department of Otolaryngology and Communication Sciences, State University of New York Upstate Medical University

Robert M Kellman, 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 Neurotology Society, American Rhinologic Society, American Society for Head and Neck Surgery, Medical Society of the State of New York, and Triological Society

Disclosure: Revent Medical Honoraria Review panel membership; Synthes Nursing Education Honoraria Other

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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Frontal view of a patient with Apert syndrome. Note the classic stigmata of exophthalmos, hypoplastic maxilla, saddle-nose deformity, and craniofacial dysostosis.
Lateral view of a patient with Apert syndrome. Note the orbital exorbitism and maxillary deficiency.
Lateral postoperative view of a patient with Apert syndrome and an external distractor in place. Note the improvement in the midface projection.
Lateral preoperative view of a patient with Crouzon syndrome. Note the obvious characteristics of mandibular prognathism, small maxilla, exophthalmos, and parrot-beaked nose.
Lateral preoperative cephalogram demonstrates midface regression despite the use of the traditional approach of osteotomy and immediate advancement.
Lateral postoperative view of a patient with Crouzon syndrome and an external distractor in place. Note advancement of the maxilla and correction of mandibular prognathism.
Lateral view demonstrates grossly evident maxillary hypoplasia in a patient with Pfeiffer syndrome.
Frontal view of a patient with Pfeiffer syndrome and maxillary retrusion severe enough to require a tracheotomy.
Lateral postoperative view of a patient with Pfeiffer syndrome and an internal distractor. Note evidence of midface improvement. Decannulation was performed several weeks later.
Three-dimensional reconstructed CT scan demonstrates preoperative maxillary deficiency.
Three-dimensional reconstructed CT scan demonstrates preoperative maxillary deficiency.
Postoperative reconstructed 3-dimensional CT scan in the same patient as in Images 10-11 depicts improved skeletal balance with advancement of the mid face.
Postoperative reconstructed 3-dimensional CT scan in the same patient as in Images 10-12 depicts improved skeletal balance with advancement of the mid face.
Left maxilla.
 
 
 
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