Distraction Osteogenesis in Oral and Craniomaxillofacial Reconstructive Surgery

Abstract

Distraction osteogenesis (DO) is a tissue engineering method to regenerate new bone. The application of DO in the field of oral and craniomaxillofacial surgery has provided a promising alternative as it can be integrated with conventional surgical technique for bone lengthening or expansion. This technique has the advantages of providing superior amount of bone lengthening thus eliminating the need of autogenous graft and donor site morbidity, can be applied in young patients and allows simultaneous expansion of the surrounding soft tissues. In this chapter, we provide a comprehensive overview of the background history and development of DO which is based on Ilizarov technique, along with its basic principles, indications, classification of DO devices and protocol in craniomaxillofacial bone lengthening or expansion. Its clinical applications which include alveolar DO, mandible DO, maxilla DO, transport DO and craniofacial DO are clarified. This technique however requires proper understanding of clinical and technical components to avoid potential complications which include relapse, infection, adjacent structure injury, device failure and other complications. The emerging results of research and advances in DO are further elaborated at the end of this chapter.

Overview of methods for enhancing bone regeneration in distraction osteogenesis: Potential roles of biometals

“…Hippocrates was the first to propose the placement of traction forces to aid in bone healing more than 2000 years ago [ 1 ]. In the modern era, it was Codivilla who first applied bone elongation techniques in 1905, publishing a case report of a femoral distraction osteogenesis [ 2 ]. Since being developed in the 1950s, the Ilizarov transportation technique—also known as “DO technique”—has become an important technique in the fields of oral, maxillofacial, and orthopedic surgeries [ [3] , [4] , [5] , [6] ].…”

“…The procedure of DO is composed of three sequential phases including latency, distraction, and consolidation [ 2 ]. In the latency phase, bone segments are fixed for 5–7 days after the osteotomy, as suggested by Ilizarov [ 4 ].…”

“…The consolidation phase usually takes half to one year or longer to accomplish and contains a long period of immobilization as the distracted callus becomes mature with the mechanical support from the fixation device, keeping the callus stable and preventing cartilaginous formation in-between. During the consolidation phase, bone remodeling starts by allowing the formation of lamellar bone with bone marrow elements to help form a better remodeling structure, which can provide mechanical support over a long period of time [ 2 ]. The biological processes involved in the consolidation phase consist of bone columns interconnecting, osteoclast recruitment, and bone remodeling [ 13 ].…”

“…Automated continuous devices: Novel distraction devices that can lengthen automatically and continuously have been developed. The automated distraction is of clinical significance since it can eliminate the need for patient compliance and diminish the frequency of postoperative care [ 2 ]. There are three types of automated devices for DO: hydraulic power, motor-driven, and spring-mediated devices [ 35 ].…”

“…Growth factor-based therapy: Local or systematic administration of growth factors have been reported to promote bone formation including BMP [ 54 ], osteogenic growth peptide (OGP) [ 55 ], platelet-derived growth factor (PDGF) [ 9 ], VEGF [ 9 ], nerve growth factor (NGFβ), and calcitonin gene-related peptide (CGRP). Among these growth factors, BMP plays the most important role in bone healing through regulating osteogenic differentiation of MSCs and synergistic effects with VEGF signaling [ 2 ]. Local application of BMP-2 in the distraction phase effectively enhances consolidation in DO [ 54 ].…”