Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Distraction Osteogenesis of the Mandible Treatment & Management

  • Author: Dale A Baur, MD, DDS; Chief Editor: Arlen D Meyers, MD, MBA  more...
 
Updated: Mar 08, 2016
 

Surgical Therapy

Costantino and Friedman classify possible distraction approaches to bone defects as follows[12] :

  • Monofocal: A surgical fracture creates a distraction gap (the interval between 2 bone surfaces where the healing events will happen) for posterior traction of the separated bone segments. This is the conventional for vertical alveolar augmentation prior to implant placement.
  • Bifocal: A solution of continuity is treated by moving a surgically produced bone segment along the defect from one extremity to the other. The moving segment is a transport disc. This approach is frequently used for mandibular reconstructions after tumor ablation.
  • Trifocal: Two transport discs are created from 2 extremities of defect and moved until they meet. Usually major corrections are done with trifocal processes.

The orthodontist and the surgeon must have frequent communication throughout the entire planning process, and must share the same treatment objectives.

Next

Preoperative Details

After the workup is completed, the placement of the osteotomy and the selection of the distraction device should be determined. Either an internal (intraoral) device or an external device is used, though most routine cases can be done intraorally. Patients accept internal devices better than external ones, but the former are difficult to use in patients with small bones. External devices offer flexibility and vector selection but often cause scarring of the skin.

On the basis of the mandibular defect, the surgeon must determine where to place the osteotomy. As a general rule, if the mandible is defective in a ramus height, the osteotomy should be placed superior to the angle on the ramus, with a distractor placed in a vertical plane. If the mandible is deficient in body length, the osteotomy should be placed anterior to the angle, with the distractor device placed across the defect in a horizontal plane. If the mandible has a combination of defects, the device needs to be placed in an oblique plane. As an alternative, the surgeon may use an external multivector device with 2 osteotomies, 1 anterior and 1 superior to the angle, and 3 pins placed to obtain a multivector advancement.

Previous
Next

Intraoperative Details

The patient receives prophylactic antibiotics and nasoendotracheal general anesthesia. An incision is made in the facial vestibule of the mandible, perpendicular to the osteotomy site. A subperiosteal plane is carefully developed to expose the osteotomy site, while an intact periosteal layer is maintained. The osteotomy is placed in the predetermined position on the basis of the findings on the preoperative workup.

Depending on the surgeon's preference, a reciprocating saw or a fissure bur can be used to perform the osteotomy, staying clear of the inferior alveolar nerve bundle by 3-5 mm. Lateral, superior, and inferior aspects of the mandible are cut, leaving the mid portion of the lingual cortex intact, as depicted in the 1st image below. Care should be taken to preserve as much osteogenic tissue as possible, including periosteal and endosteal blood supply. The intraoral distraction device is now secured to the mandible with screw fixation, as depicted in the 2nd image below. The osteotomy is then completed by using a series of osteotomes on the inferior and superior borders and on the lingual aspect. At this point, activation is attempted to ensure movement of the proximal and distal segments. The device is then returned to its starting position. The tissue is carefully closed over the device.

Distraction osteogenesis of the mandible. A recipr Distraction osteogenesis of the mandible. A reciprocating saw is used to osteotomize inferior, lateral, and superior portions of the mandible. An osteotome is then used to complete the bony cut. Courtesy of Jordan Mastrodonato, MS, Medical Illustrator, Eisenhower Army Medical Center.
Distraction osteogenesis of the mandible. Intraora Distraction osteogenesis of the mandible. Intraoral distraction device in place. Courtesy of K.L.S. Martin, LP.

When mandibular symphyseal osteotomy is performed, access is obtained through the usual genioplasty incision. The osteotomy is started through the body of the mandible with a saw. The device is secured in position, and a thin osteotome is then used to complete the bony cut through the alveolar process and between the teeth, attempting to maintain the integrity of the soft tissue and avoid damaging teeth.

When a continuity defect of the mandible is encountered, the surgeon can use distraction osteogenesis or, more specifically, transport osteogenesis (instead of a bone graft) to address this problem. An osteotomy is performed on either the proximal segment or the distal segment, resulting in a transport disk of bone at least 1.5-2 cm in thickness. After the latency period, this disk is transported across the mandibular defect, following the usual rate and rhythm protocol. After the entire defect has been traversed with the disk, the surgeon allows for consolidation. On occasion, a small bone graft is placed at the interface of the disk and on the opposite side, where consolidation is not always complete.

Previous
Next

Postoperative Details

The traditional latency period is 5-7 days. Young children have an increased bone metabolism and may have a latency period as short as 24-48 hours, without affecting ultimate consolidation. Waiting too long increases the risk of bony union; waiting 7 days is advised if the periosteum is excessively traumatized. In addition, if both hard tissue and soft tissue are less than ideal in quality or quantity, increasing the latency period may be considered.

As mentioned before and according to most study results, the recommended rate of distraction is 1 mm per day. A slower rate could result in premature bony union, whereas a faster rate could result in a fibrous union. The inferior alveolar nerve seems to tolerate a distraction rate of 1 mm/d. Ilizarov recommended a continuous rhythm for distraction; however, this is not feasible in the clinical setting, so a rhythm of 1-2 times per day is recommended. The surgeon or a responsible adult should activate the appliance. During a bilateral mandibular advancement, an anterior open bite tends to develop; this can be corrected at the end of advancement with orthodontic elastics.

The consolidation phase is typically 8 weeks, although some adults may require up to 12 weeks of consolidation. Reports have described the use of adjunctive therapies and their potential to enhance optimization of the consolidation period. Among these, bone morphogenic protein 2 (BMP-2), growth hormones, osteoblastlike cells, and therapeutic low-level laser are reported to demonstrate improved bone healing.[13, 14, 15, 16, 17] Thus, these supportive treatments remain as viable strategies to provide high-quality regenerate and shorten overall healing. During the consolidation phase, the fixation must be rigid enough to prevent the formation of fibrous tissue but not too rigid to prevent physiologic loading of the new bone. The formation of the regenerate can be monitored with serial radiographs or CT scans.

These procedures can often be performed on an outpatient basis, although some patients may require 1-2 days of hospitalization for postoperative care. After the consolidation phase is complete, the device can be removed using intravenous sedation and local anesthesia. Orthodontic detailing of the occlusion can begin 3-6 months after the consolidation phase.

In bilateral expansion of the mandible, the patient should be distracted until a slight class III dental occlusion exists (edge-edge incisal relationship). In a unilateral expansion, a slight overcorrection of the mandibular midline is recommended to overcome the deficient soft tissue envelope.

During the distraction phase, the patient is examined every 2-3 days to monitor the advancement and to detect potential occlusal discrepancies. During the consolidation phase, the patient should be seen on a weekly basis to monitor healing and ossification of the regenerate.

Previous
Next

Follow-up

See Postoperative details.

Previous
Next

Complications

With experience, the overall complication rate is low. Complications include the following: fibrous nonunion or premature union of bone, infection that may hinder osteogenesis, noncompliant patient with treatment failure, scarring of the skin with external devices, hardware failure, and malocclusion because of improper vectors.

Although rare, relapses, temporomandibular joint ankylosis, fracture of the mandible or the transport segment and resorption of the transport segment have also been reported.[18, 19, 20] See the image below.

Temporomandibular joint ankylosis following distra Temporomandibular joint ankylosis following distraction osteogenesis

Soft tissue dehiscence or device exposure is not necessarily considered as a complication.

Previous
Next

Outcome and Prognosis

Distraction osteogenesis of the mandible has become a commonplace procedure with the flexibility to allow the surgeon to address a wide variety of mandibular defects. The sophistication of the distraction devices has increased in the last few years, allowing multivector movement of the mandible. A high percentage of patients accept intraoral distraction with a small, low-profile distraction device.

Although traditional mandibular osteotomy, such as bilateral sagittal split osteotomy, will always have a role, distraction osteogenesis allows a surgeon to treat patients who are unable or unwilling to undergo traditional osteotomy. Distraction osteogenesis is a highly predictable and reliable method of increasing the bone in a deficient mandible.

Previous
Next

Future and Controversies

With technologic advancements, distraction devices have become smaller and more sophisticated than early versions. Distraction osteogenesis may even be teamed with endoscopic techniques to allow the placement of these devices with minimal surgery.

Preliminary studies of rabbits have shown that distraction performed in the presence of recombinant human bone morphogenetic protein placed into the distraction site accelerates bone formation.

Distraction osteogenesis is showing great promise in the treatment of OSA. Although traditional combined maxillary and mandibular osteotomy are effective in treating mild-to-moderate OSA, the results are disappointing in patients with severe OSA (RDI >60) and/or a high BMI (>28). This is likely because traditional mandibular osteotomy has a physiologic limit of about 10 mm of advancement, which may be insufficient to open the airway for effective relief of the obstruction in the obese patient or in those with severe disease.

Distraction osteogenesis allows for advancement of up to 25 mm by using a specially designed distraction device, as depicted in the image below. In effect, the amount of distraction is individualized for each patient by performing polysomnography (PSG) after about 15-18 mm of advancement. If the PSG demonstrates a normal RDI, distraction is stopped to allow for consolidation. If the RDI is still elevated, distraction continues for the full 25 mm.

Mandibular distractor used for maxillomandibular a Mandibular distractor used for maxillomandibular advancement for the treatment of OSA. Courtesy of K.L.S. Martin, LP.

As part of this treatment protocol, the patient undergoes a LeFort I osteotomy with down fracture and then placed in intermaxillary fixation to allow the distraction device to move the maxilla and mandible as a unit and maintain the preexisting dental occlusion. In addition, the patient receives elective tracheotomy for airway protection. During PSG, the tracheotomy is occluded to avoid confounding the results.

When the distraction phase is completed, the cannula is removed. The consolidation phase is approximately 4 months, after which the device is removed. In 1 case series, this protocol was highly effective in the management of severe OSA. Patient selection and compliance are important for the success of this procedure.

One controversy involves the use of distraction osteogenesis instead of traditional bilateral sagittal split osteotomy. Some authors have stated that bilateral sagittal split osteotomy is an obsolete procedure with no role in current practice. In reality, traditional mandibular osteotomies will always have a role; however, distraction osteogenesis gives the surgeon another option in treating a wide variety of mandibular deficiencies.

Other research directions on distraction osteogenesis are as follows:

  • Administration of growth factors to enhance bone healing: Bone morphogenic proteins 2 and 4, transforming growth factor-beta (TGF-beta), platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), and fibroblast growth factor (FGF) applications have demonstrated promising results to accelerate bone healing in distraction osteogenesis. [21, 22, 23, 24]
  • Resorbable distractors: Resorbable mandibular distractors, when combined with advances in resorbable materials and distraction, may enable predictable distraction with a single operation. [25, 26]
  • Continuous distraction osteogenesis: Automatic distraction systems that can activate continuous distraction are a promising alternative in distraction osteogenesis. Bone healing is accelerated with continuous distraction when compared with intermitted distraction. [27, 28]
Previous
 
Contributor Information and Disclosures
Author

Dale A Baur, MD, DDS Associate Professor and Chair, Department of Oral and Maxillofacial Surgery, Case Western Reserve University School of Medicine; Division Chief, Oral and Maxillofacial Surgery, University Hospitals/Case Medical Center

Dale A Baur, MD, DDS is a member of the following medical societies: American Association of Oral and Maxillofacial Surgeons, American College of Oral and Maxillofacial Surgeons, American Dental Association

Disclosure: consulting fee from Novartis pharmaceuticals for consulting; Received fee from Checkpoint Surgical LLC. for consulting. for: Novartis Pharmaceuticals, Checkpoint Surgical LLC.

Coauthor(s)

Joseph Helman, DMD C J Lyons Endowed Professor, Department of Oral and Maxillofacial Surgery, University of Michigan Medical School

Joseph Helman, DMD is a member of the following medical societies: American Association of Oral and Maxillofacial Surgeons, American Cleft Palate-Craniofacial Association, American Head and Neck Society, International Academy of Oral Oncology, American College of Oral and Maxillofacial Surgeons

Disclosure: Nothing to disclose.

Juan Carlos Rodriguez, DDS Research Associate, Department of Oral and Maxillofacial Surgery, Case Western Reserve University School of Medicine

Disclosure: Nothing to disclose.

Mehmet Ali Altay, DDS, PhD Research Fellow, Department of Oral and Maxillofacial Surgery, Case Western Reserve University School of Dental Medicine; Doctor of Oral and Maxillofacial Surgery, Faculty of Dentistry, Akdeniz University, Turkey

Mehmet Ali Altay, DDS, PhD is a member of the following medical societies: International Association of Oral and Maxillofacial Surgeons, Turkish Association of Oral and Maxillofacial Surgeons

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Checkpoint Surgical LLC.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

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 Head and Neck Society, American Rhinologic Society, Triological Society, American Neurotology Society, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, Medical Society of the State of New York

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, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan;RxRevu;SymbiaAllergySolutions<br/>Received income in an amount equal to or greater than $250 from: Symbia<br/>Received from Allergy Solutions, Inc for board membership; Received honoraria from RxRevu for chief medical editor; Received salary from Medvoy for founder and president; Received consulting fee from Corvectra for senior medical advisor; Received ownership interest from Cerescan for consulting; Received consulting fee from Essiahealth for advisor; Received consulting fee from Carespan for advisor; Received consulting fee from Covidien for consulting.

Additional Contributors

Mimi S Kokoska, MD Physician, Department of Otolaryngology-Head and Neck Surgery, Aurora Health Care

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 Association for Physician Leadership, American College of Surgeons, American Head and Neck Society

Disclosure: Nothing to disclose.

References
  1. Ilizarov GA, Ledyaev VI. The replacement of long tubular bone defects by lengthening distraction osteotomy of one of the fragments. 1969. Clin Orthop Relat Res. 1992 Jul. 7-10. [Medline].

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

  3. Tibesar RJ, Price DL, Moore EJ. Mandibular distraction osteogenesis to relieve Pierre Robin airway obstruction. Am J Otolaryngol. 2006 Nov-Dec. 27(6):436-9. [Medline].

  4. González-García R, Naval-Gías L, Rodríguez-Campo FJ. Distraction osteogenesis in the irradiated mandible for segmental mandibular reconstruction. J Oral Maxillofac Surg. 2009 Jul. 67(7):1573-4. [Medline].

  5. Meyer U, Kruse-Lösler B, Wiesmann HP. Principles of bone formation driven by biophysical forces in craniofacial surgery. Br J Oral Maxillofac Surg. 2006 Aug. 44(4):289-95. [Medline].

  6. Hong P, Boyd D, Beyea SD, Bezuhly M. Enhancement of bone consolidation in mandibular distraction osteogenesis: a contemporary review of experimental studies involving adjuvant therapies. J Plast Reconstr Aesthet Surg. 2013 Jul. 66(7):883-95. [Medline].

  7. Hong P. A clinical narrative review of mandibular distraction osteogenesis in neonates with Pierre Robin sequence. Int J Pediatr Otorhinolaryngol. 2011 Aug. 75(8):985-91. [Medline].

  8. Saulacic N, Zix J, Iizuka T. Complication rates and associated factors in alveolar distraction osteogenesis: a comprehensive review. Int J Oral Maxillofac Surg. 2009 Mar. 38(3):210-7. [Medline].

  9. Hwang SJ, Jung JG, Jung JU, Kyung SH. Vertical alveolar bone distraction at molar region using lag screw principle. J Oral Maxillofac Surg. 2004 Jul. 62(7):787-94. [Medline].

  10. Rachmiel A, Srouji S, Peled M. Alveolar ridge augmentation by distraction osteogenesis. Int J Oral Maxillofac Surg. 2001 Dec. 30(6):510-7. [Medline].

  11. Clark CL, Strider J, Hall C, Ferguson HW, Armstrong KL, Runner RR. Distraction osteogenesis in irradiated rabbit mandibles with adjunctive hyperbaric oxygen therapy. J Oral Maxillofac Surg. 2006 Apr. 64(4):589-93. [Medline].

  12. Costantino PD, Friedman CD. Distraction osteogenesis. Applications for mandibular regrowth. Otolaryngol Clin North Am. 1991 Dec. 24(6):1433-43. [Medline].

  13. Pereira MA, Luiz de Freitas PH, da Rosa TF, Xavier CB. Understanding distraction osteogenesis on the maxillofacial complex: a literature review. J Oral Maxillofac Surg. 2007 Dec. 65(12):2518-23. [Medline].

  14. Cho BC, Kim JY, Lee JH, Chung HY, Park JW, Roh KH. The bone regenerative effect of chitosan microsphere-encapsulated growth hormone on bony consolidation in mandibular distraction osteogenesis in a dog model. J Craniofac Surg. 2004 Mar. 15(2):299-311; discussion 312-3. [Medline].

  15. Ashinoff RL, Cetrulo CL Jr, Galiano RD, Dobryansky M, Bhatt KA, Ceradini DJ. Bone morphogenic protein-2 gene therapy for mandibular distraction osteogenesis. Ann Plast Surg. 2004 Jun. 52(6):585-90; discussion 591. [Medline].

  16. Freddo AL, Hübler R, de Castro-Beck CA, Heitz C, de Oliveira MG. A preliminary study of hardness and modulus of elasticity in sheep mandibles submitted to distraction osteogenesis and low-level laser therapy. Med Oral Patol Oral Cir Bucal. 2012 Jan. 17(1):e102-7. [Medline].

  17. Kreisner PE, Blaya DS, Gaião L, Maciel-Santos ME, Etges A, Santana-Filho M. Histological evaluation of the effect of low-level laser on distraction osteogenesis in rabbit mandibles. Med Oral Patol Oral Cir Bucal. 2010 Jul. 15(4):e616-8. [Medline].

  18. Chiapasco M, Consolo U, Bianchi A, Ronchi P. Alveolar distraction osteogenesis for the correction of vertically deficient edentulous ridges: a multicenter prospective study on humans. Int J Oral Maxillofac Implants. 2004 May-Jun. 19(3):399-407. [Medline].

  19. Robiony M, Toro C, Stucki-McCormick SU, Zerman N, Costa F, Politi M. The "FAD" (Floating Alveolar Device): a bidirectional distraction system for distraction osteogenesis of the alveolar process. J Oral Maxillofac Surg. 2004 Sep. 62(9 Suppl 2):136-42. [Medline].

  20. Mazzonetto R, Allais M, Maurette PE, Moreira RW. A retrospective study of the potential complications during alveolar distraction osteogenesis in 55 patients. Int J Oral Maxillofac Surg. 2007 Jan. 36(1):6-10. [Medline].

  21. Zheng LW, Wong MC, Rabie AB, Cheung LK. Evaluation of recombinant human bone morphogenetic protein-2 in mandibular distraction osteogenesis in rabbits: Effect of dosage and number of doses on formation of bone. Br J Oral Maxillofac Surg. 2006 Dec. 44(6):487-94. [Medline].

  22. Kim IS, Park JW, Kwon IC, Baik BS, Cho BC. Role of BMP, betaig-h3, and chitosan in early bony consolidation in distraction osteogenesis in a dog model. Plast Reconstr Surg. 2002 May. 109(6):1966-77. [Medline].

  23. Jiang X, Zou S, Ye B, Zhu S, Liu Y, Hu J. bFGF-Modified BMMSCs enhance bone regeneration following distraction osteogenesis in rabbits. Bone. 2010 Apr. 46(4):1156-61. [Medline].

  24. Cho BC, Moon JH, Chung HY, Park JW, Kweon IC, Kim IS. The bone regenerative effect of growth hormone on consolidation in mandibular distraction osteogenesis of a dog model. J Craniofac Surg. 2003 May. 14(3):417-25. [Medline].

  25. Gateno J, Seymour-Dempsey K, Teichgraeber JF, Lalani Z, Yanez R, Xia JJ. Prototype testing for a new bioabsorbable Le Fort III distraction device: a pilot study. J Oral Maxillofac Surg. 2004 Dec. 62(12):1517-23. [Medline].

  26. Cohen SR, Holmes RE. Internal Le Fort III distraction with biodegradable devices. J Craniofac Surg. 2001 May. 12(3):264-72. [Medline].

  27. Goldwaser BR, Magill J, Papadaki ME, Byl M, Kromann R, Yates B. Continuous mandibular distraction osteogenesis: novel device and preliminary results in minipigs. J Oral Maxillofac Surg. 2013 Apr. 71(4):e168-77. [Medline].

  28. Peacock ZS, Tricomi BJ, Murphy BA, Magill JC, Kaban LB, Troulis MJ. Automated continuous distraction osteogenesis may allow faster distraction rates: a preliminary study. J Oral Maxillofac Surg. 2013 Jun. 71(6):1073-84. [Medline].

  29. Alkan A, Ozer M, Bas B, Bayram M, Celebi N, Inal S. Mandibular symphyseal distraction osteogenesis: review of three techniques. Int J Oral Maxillofac Surg. 2007 Feb. 36(2):111-7. [Medline].

  30. Azumi Y, Sugawara J, Takahashi I, Mitani H, Nagasaka H, Kawamura H. Positional and morphologic changes of the mandibular condyle after mandibular distraction osteogenesis in skeletal class II patients. World J Orthod. 2004 Spring. 5(1):32-9. [Medline].

  31. Block MS, Brister GD. Use of distraction osteogenesis for maxillary advancement: preliminary results. J Oral Maxillofac Surg. 1994 Mar. 52(3):282-6; discussion 287-8. [Medline].

  32. Breuning KH, van Strijen PJ, Prahl-Andersen B, Tuinzing DB. Duration of orthodontic treatment and mandibular lengthening by means of distraction or bilateral sagittal split osteotomy in patients with Angle Class II malocclusions. Am J Orthod Dentofacial Orthop. 2005 Jan. 127(1):25-9. [Medline].

  33. Chin M, Toth BA. Distraction osteogenesis in maxillofacial surgery using internal devices: review of five cases. J Oral Maxillofac Surg. 1996 Jan. 54(1):45-53; discussion 54. [Medline].

  34. Clark CL, Strider J, Hall C, Ferguson HW, Armstrong KL, Runner RR, et al. Distraction osteogenesis in irradiated rabbit mandibles with adjunctive hyperbaric oxygen therapy. J Oral Maxillofac Surg. 2006 Apr. 64(4):589-93. [Medline].

  35. Delloye C, Delefortrie G, Coutelier L, Vincent A. Bone regenerate formation in cortical bone during distraction lengthening. An experimental study. Clin Orthop Rel Res. 1990. 250: 34-42.

  36. Douglas P. Sinn, DDS, Wichit Taranon, DDS. Three-Dimensional Planning for Mandibular Distraction Osteogenesis in Hemifacial Microsomia Patients: Prediction Tracing and Results. [Full Text].

  37. Eski M, Turegun M, Deveci M, Gokce HS, Sengezer M. Vertical distraction osteogenesis of fibular bone flap in reconstructed mandible. Ann Plast Surg. 2006 Dec. 57(6):631-6. [Medline].

  38. Fritz MA, Sidman JD. Distraction osteogenesis of the mandible. Curr Opin Otolaryngol Head Neck Surg. 2004 Dec. 12(6):513-8. [Medline].

  39. González-García R, Naval-Gías L, Rodríguez-Campo FJ. Distraction osteogenesis in the irradiated mandible for segmental mandibular reconstruction. J Oral Maxillofac Surg. 2009 Jul. 67(7):1573-4. [Medline].

  40. Grayson BH, McCormick S, Santiago PE, McCarthy JG. Vector of device placement and trajectory of mandibular distraction. J Craniofac Surg. 1997 Nov. 8(6):473-80; discussion 481-2. [Medline].

  41. Guerrero CA, Bell WH, Gonzalez M. Intraoral distraction osteogenesis. Oral and Maxillofacial Surgery. Fonseca RJ, ed. Philadelphia: WB Saunders Co; 2000. Vol 2: 380-402.

  42. Gugenheim JJ Jr. The Ilizarov method. Orthopedic and soft tissue applications. Clin Plast Surg. 1998 Oct. 25(4):567-78. [Medline].

  43. Helman JI, Cottrell K, Garetz R. Outcome assessments in the surgical management of obstructive sleep apnea. Zurich, Switzerland: International Symposium on Problems and Complications in Corrective Surgery of Facial Skeletal Anomalies. University of Zurich; 2003.

  44. Hollier LH Jr, Higuera S, Stal S, Taylor TD. Distraction rate and latency: factors in the outcome of pediatric mandibular distraction. Plast Reconstr Surg. 2006 Jun. 117(7):2333-6. [Medline].

  45. Imola MJ. Craniofacial Distraction Osteogenesis. Medscape Reference Journal [serial online]. 2003. Available at: http://emedicine.medscape.com/article/844659-overview. [Full Text].

  46. Janette AJ, Vicari FA, Baurer BS. Treatment of upper airway obstruction secondary to mandibular deficiency by distraction osteogenesis [abstract presentation]. American Association of Oral and Maxillofacial Surgeons. 1995.

  47. Kunz C, Adolphs N, Buescher P, Hammer B, Rahn B. Distraction osteogenesis of the canine mandible: the impact of acute callus manipulation on vascularization and early bone formation. J Oral Maxillofac Surg. 2005 Jan. 63(1):93-102. [Medline].

  48. Malkoç S, Iseri H, Karaman AI, Mutlu N, Küçükkolbasi H. Effects of mandibular symphyseal distraction osteogenesis on mandibular structures. Am J Orthod Dentofacial Orthop. 2006 Nov. 130(5):603-11. [Medline].

  49. McCormick SU. Facial asymmetry. The diagnostic challenge. Atlas Oral Maxillofac Surg Clin North Am. 1996 Mar. 4(1):1-18. [Medline].

  50. McCormick SU, Grayson BH, McCarthy JG, Staffenberg D. Effect of mandibular distraction on the temporomandibular joint: Part 2, Clinical study. J Craniofac Surg. 1995 Sep. 6(5):364-7. [Medline].

  51. McKibbin B. The biology of fracture healing in long bones. J Bone Joint Surg. 1978. 60-B: 150-162.

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

  53. Ortakoglu K, Karacay S, Sencimen M, Akin E, Ozyigit AH, Bengi O. Distraction osteogenesis in a severe mandibular deficiency. Head Face Med. 2007. 3:7. [Medline].

  54. Ortiz Monasterio F, Molina F, Andrade L, Rodriguez C, Sainz Arregui J. Simultaneous mandibular and maxillary distraction in hemifacial microsomia in adults: avoiding occlusal disasters. Plast Reconstr Surg. 1997 Sep. 100(4):852-61. [Medline].

  55. Paley D, Tetsworth K. Mechanical axis deviation of the lower limbs. Preoperative planning of uni-apical angular deformities of the tibia or femur. Clin Orthop Rel Res. 1992. 280: 48-64.

  56. Paterson D. Leg-lengthening procedures. A historical review. Clin Orthop Relat Res. 1990 Jan. 27-33. [Medline].

  57. Rachmiel A, Aizenbud D, Pillar G, Srouji S, Peled M. Bilateral mandibular distraction for patients with compromised airway analyzed by three-dimensional CT. Int J Oral Maxillofac Surg. 2005 Jan. 34(1):9-18. [Medline].

  58. Rachmiel A, Jackson IT, Potparic Z, Laufer D. Midface advancement in sheep by gradual distraction: a 1-year follow-up study. J Oral Maxillofac Surg. 1995 May. 53(5):525-9. [Medline].

  59. Sayan NB, Karasu HA, Uyank LO. Two-stage treatment of TMJ ankylosis by early surgical approach and distraction osteogenesis. J Craniofac Surg. 2007. 18(1):212-7.

  60. Snyder CC, Levine GA, Swanson HM, Browne EZ Jr. Mandibular lengthening by gradual distraction. Preliminary report. Plast Reconstr Surg. 1973 May. 51(5):506-8. [Medline].

  61. Stucki-McCormick SU, Fox RM, Mizrahi R. Distraction osteogenesis: a unique treatment for congenital micrognathias. Fonseca RJ, ed. Philadelphia: WB Saunders Co; 2000. 347-58.

  62. Taylor TD, Stal S. Applications of distraction osteogenesis. Part I. Clin Plast Surg. 1998 Oct. 25(4):553-60, viii. [Medline].

  63. Thompson SH, Quinn M, Helman JI. In press. Maxillomandibular distraction osteogenesis advancement for the treatment of OSA, a case report.

  64. Tucker MR. Management of severe mandibular retrognathia in the adult patient using traditional orthognathic surgery. J Oral Maxillofac Surg. 2002 Nov. 60(11):1334-40. [Medline].

  65. Waanders NA, Herzenberg JE, Goulet JA. A morphologic study of the regenerate bone structure in the early stages of distraction osteogenesis. Bull Hosp Joint Dis Orthop Inst. 1992. 52(1).

  66. Walker DA. Management of severe mandibular retrognathia in the adult patient using distraction osteogenesis. J Oral Maxillofac Surg. 2002 Nov. 60(11):1341-6. [Medline].

  67. Yasui N, Kojimoto H, Sasaki K, Kitada A, Shimizu H, Shimomura Y. Factors affecting callus distraction in limb lengthening. Clin Orthop Rel Res. 1993. 293: 55-60.

  68. Yasui N, Kojimoto H, Shimizu H, Shimomura Y. The effect of distraction upon bone, muscle, and periosteum. Orthop Clin North Am. 1991 Oct. 22(4):563-7. [Medline].

  69. Yonezawa H, Harada K, Ikebe T, Shinohara M, Enomoto S. Effect of recombinant human bone morphogenetic protein-2 (rhBMP-2) on bone consolidation on distraction osteogenesis: a preliminary study in rabbit mandibles. J Craniomaxillofac Surg. 2006 Jul. 34(5):270-6. [Medline].

 
Previous
Next
 
Distraction osteogenesis of the mandible. Alveolar distractor used to increase the height of the alveolar bone. Courtesy of K.L.S. Martin, LP.
Distraction osteogenesis of the mandible. A reciprocating saw is used to osteotomize inferior, lateral, and superior portions of the mandible. An osteotome is then used to complete the bony cut. Courtesy of Jordan Mastrodonato, MS, Medical Illustrator, Eisenhower Army Medical Center.
Distraction osteogenesis of the mandible. Intraoral distraction device in place. Courtesy of K.L.S. Martin, LP.
Temporomandibular joint ankylosis following distraction osteogenesis
Mandibular distractor used for maxillomandibular advancement for the treatment of OSA. Courtesy of K.L.S. Martin, LP.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.