Distraction Osteogenesis: Mandible and Maxilla

Abstract

Mandibular and maxillary deformities commonly require surgical intervention. Prior to distraction osteogenesis, traditional modalities involving single-staged translocation and rigid fixation were used to correct these craniofacial anomalies. Distraction osteogenesis has evolved as a compelling alternative for treating aesthetic and functional dentofacial defects. The process of distraction osteogenesis involves three phases—latency, activation, and consolidation—which allow for appropriate translation of the affected craniofacial skeleton. This review will cover the role of distraction for managing congenital and acquired deformities of the mandible and maxilla. This novel technique can be performed at numerous anatomical sites along the craniofacial skeleton to treat a variety of anomalies, which serves as a testament to its adaptability and efficacy. Importantly, distraction osteogenesis also has the ability to simultaneously increase bone length and the overlying soft tissue envelope. This advantage results in larger advancements with reduced relapse rates and improved patient satisfaction. While complications remain a concern, it stands to reason that the measurable benefits observed underscore the power and versatility of distraction osteogenesis.

Elevated Intracranial Pressure After Primary Surgical Correction of Sagittal Suture Craniosynostosis

“…Chiefly, this operative modality obviates subjective interpretation and demonstrates reproducible and reliable post-surgical outcomes. 25,27,28 While VSP does not serve to replace surgeon operative skills, it minimizes user error and allows for optimal results tailored individually to each patient. Additionally, VSP leads to reduced surgical time and enhanced operative outcomes.…”

Functional Approaches in Promoting Vascularization and Angiogenesis in Bone Critical-Sized Defects via Delivery of Cells, Growth Factors, Drugs, and Particles

“…Distraction osteogenesis is a surgical technique of bone regeneration via lengthening [ 38 , 39 ]. Specifically, two segments of bone are gradually separated, and new bone is regenerated in the between gap [ 40 ].…”

Craniofacial Distraction Osteogenesis

“…58,61,62 Le Fort I Distraction Le Fort I DO is used in patients with isolated maxillary retrusion, and has largely replaced traditional Le Fort I advancement in CLP patients requiring large advancements (>10 mm; ►Table 3). 14,57,59 Once Le Fort I osteotomies are performed, the mobilized maxilla is attached to the distractor at the desired vector that achieves optimal maxillary position and occlusal alignment. 14 Internal distractors are more often used for Le Fort I DO, and the consolidation phase is typically 8 to 12 weeks.…”

“…58 During the Le Fort II procedure, the nasomaxillary region is often advanced in the vertical and coronal plane, which improves facial contour, upper airway patency, and occlusion. 54,57 Following Le Fort II osteotomies, the nasomaxillary complex is distracted. External distractors are preferred due to the frequent need for multivector advancement.…”

“…The utilization of DO in Le Fort III procedures has shown to result in larger advancement distances, shorter operations, and a lower risk of relapse when compared to conventional Le Fort III advancement (►Tables 1 and 3). 14,54,57,60 Le Fort III advancement is often avoided in young children due to the high risk of midfacial growth impairment and need for secondary procedures. 63 If a Le Fort III advancement is required before skeletal maturity due to severe anatomic airway obstruction, distraction can be used with overcorrection of the anterior maxillary positioning to plan for postoperative phenotypic relapse.…”