Distraction Osteogenesis of the Mandible Workup

  • Author: Dale A Baur, DDS, MD; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Apr 17, 2012
 

Laboratory Studies

Depending on the patient's age, at a minimum, complete blood count, platelet count, and coagulation studies should be performed.

Next

Imaging Studies

A panoramic radiograph should be obtained. This imaging provides the surgeon with better visualization of mandible morphology. A preoperative planned osteotomy is drawn in the diagnosis tracing; it should include maxilla and mandible. The PA cephalometric radiograph is another diagnostic tool, used to determine the amount of vertical and transverse (horizontal) mandibular distraction. It is the best film for determining vertical distraction due to better visualization of both mandibular angles. A diagnostic tracing of the PA cephalometric radiograph is made, as well as a drawing of the osteotomy to correspond with the diagnostic tracing of the Panorex.

Complicated cases may require CT scans with 3-dimensional reconstruction and stereolithographic models to help in planning the location of the osteotomy and the vector of distraction.

Mounted dental models on a semiadjustable articulator are often helpful in determining the vector of distraction, and optimizing the dental occlusion.

Previous
Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

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

Disclosure: Nothing to disclose.

Coauthor(s)

Joseph Helman, DMD  Clinical Professor and Chair, Department of Oral and Maxillofacial Surgery, University of Michigan

Joseph Helman, DMD is a member of the following medical societies: American Association 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.

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

  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. Jul 1992;7-10. [Medline].

  2. McCarthy JG, Schreiber J, Karp N, Thorne CH, Grayson BH. Lengthening the human mandible by gradual distraction. Plast Reconstr Surg. Jan 1992;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. Nov-Dec 2006;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. Jul 2009;67(7):1573-4. [Medline].

  5. 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. Apr 2006;64(4):589-93. [Medline].

  6. 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. Feb 2007;36(2):111-7. [Medline].

  7. 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. Spring 2004;5(1):32-9. [Medline].

  8. 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. Jan 2005;127(1):25-9. [Medline].

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

  10. Douglas P. Sinn, DDS, Wichit Taranon, DDS. Three-Dimensional Planning for Mandibular Distraction Osteogenesis in Hemifacial Microsomia Patients: Prediction Tracing and Results. Available at http://journals.lww.com/jcraniofacialsurgery/pages/articleviewer.aspx?year=1999&issue=05000&article=00006&type=abstract.

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

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

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

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

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

  16. 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.

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

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

  19. 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.

  20. 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. Jan 2005;63(1):93-102. [Medline].

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

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

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

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

  25. 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].

  26. 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].

  27. 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. Sep 1997;100(4):852-61. [Medline].

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

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

  30. 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. Jan 2005;34(1):9-18. [Medline].

  31. 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.

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

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

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

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

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

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

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

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

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

  41. 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. Jul 2006;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.
Mandibular distractor used for maxillomandibular advancement for the treatment of OSA. Courtesy of K.L.S. Martin, LP.
Mandible, anterolateral superior view.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.