Maxillary Movement in Distraction Osteogenesis Using Internal Devices in Cleft Palate Patients

Tomita, Daisuke; Omura, Susumu; Ozaki, Shusaku; Shimazaki, K.; Fukuyama, Eiji; Tohnai, Iwai; Torikai, Katsuyukí

doi:10.1597/09-073

Cited by 4 publications

(16 citation statements)

References 22 publications

(34 reference statements)

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“…A complete perforative cleft was established surgically in the experimental animals to simulate the CP. 12,18,19 The expression of proteins is multiregulated from transcription to translation, and the abundance of mRNA transcript from DNA has a delicate relation with correlation ship between different The Journal of Craniofacial Surgery • Volume 25, Number 6, November 2014 Distraction Osteogenesis Reconstruction proteins translated by mRNA. In our study, osteoblast-related genes were investigated from mRNA level to protein level so as to understand the regulation mechanism of new bone formation in DO preferably in different levels.…”

Section: Discussionmentioning

confidence: 99%

“…8,9 The DO surgery enhances current treatment to induce new bone formation and soft tissue migration over the cleft, and an effort is made to preserve normal subsequent midfacial growth. [10][11][12] In the early studies, investigators established some CP models and successfully corrected the palate fissure. [13][14][15] On this basis, a new CP model on rhesus was established and corrected palate fissure and corresponding soft tissue by an approach of DO.…”

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confidence: 99%

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Analysis of Genetic Regulation and Cytokine Expressions of Distraction Osteogenesis Reconstruction for Cleft Palate

Bai¹,

Liu²,

Chen³

et al. 2014

Journal of Craniofacial Surgery

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Because cleft palate (CP) is one of the most common congenital deformities, surgeons have tried for longtime to achieve an ideal reconstruction of the palatal bone defects and restoration of muscle attachments. In this study, a new CP model on rhesus was established and corrected by an approach of distraction osteogenesis (DO), and then quantitative studies of regulation of osteogenesis genes and expression of alkaline phosphatase (ALP), insulin-like growth factor-I (IGF-I), osteopontin (OPN), and osteocalcin (OC) in different phases of new bone formation were preformed. The CP models (23 animals) were established surgically. In the experimental group (21 animals), the tissue defects were repaired by means of DO at the rhythm of 0.4 mm twice per day. The specimens were retrieved in 1, 2, 4, 6, 8, 12, and 24 weeks (3 animals each) after completion of distraction. The IGF-I, ALP, OPN, and OC messenger RNA (mRNA) were detected by real-time reverse transcription polymerase chain reaction, and their proteins were then analyzed by enzymelinked immunosorbent assay tests. The results are compared with those of the experimental control and empty control groups (2 animals each). In the distraction gap, the mRNA and protein expressions levels of IGF-I and ALP were both highly upregulated and reaching apex in the early phase of new bone formation. Otherwise, the mRNA and protein expressions of OPN and OC demonstrated high level during intermediate and later remodeling stages. These results suggest that the reconstruction of CP bone defect by means of DO could get definitely intramembraneous new bone formation and eventually quite normal bone structure via consecutive remodeling in situ.O steoblastic activities are generally divided into 3 phases, which include period of differentiation and proliferation, period of extracellular matrix formation and maturation, and period of extracellular matrix calcification. 1 Cell-type-specific and differentiationstage-specific expressions of alkaline phosphatase (ALP), insulin-like growth factor-I (IGF-I), osteopontin (OPN), and osteocalcin (OC) give valuable insights into the differentiation stages of osteogenic cells and also into the origin of the cells involved in distraction osteogenesis (DO). 2-4 Using quantitative measurement of messenger RNA (mRNA) and protein levels of these markers, we cannot only explain the state of cell func0tion and structural components of extracellular matrix changes in trends and characteristics, which in various stages of DO treatment of cleft palate (CP) and acquired palatal bone defects, but also explore the potential relationship between them. 5-7 Because these 2 different levels have respective characteristics, the results should supplement and confirm each other.Currently, surgical repair of soft palate tissues contribute to scar formation, soft palate shortening, and subsequent velopharyngeal insufficiency. These complications often necessitate further invasive procedures, thereby decreasing the need for secondary reconstructive procedures. 8,9 The...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Analysis of Genetic Regulation and Cytokine Expressions of Distraction Osteogenesis Reconstruction for Cleft Palate

Bai¹,

Liu²,

Chen³

et al. 2014

Journal of Craniofacial Surgery

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“…the discomfort due to the stretch of the buccal tissues by the distractor's rods, (7) the need for pre-operative planning and/or stereolithographic modelling [34,[50][51][52][53][54][55].…”

Section: Advantages and Disadvantagesmentioning

confidence: 99%

“…The standard LeFort I osteotomy and down fracturing of the maxilla are the most commonly performed osteotomies since this technique is used in older patients than those treated with RED [51,54,[59][60][61]. High LeFort I and the 2-3 piece LeFort I osteotomies (this can be performed after completion of distraction, at the time of device removal) are also used with this protocol [34,54].…”

Section: Technique and Protocolmentioning

confidence: 99%

“…After the insertion of the internal bone-borne maxillary distractors, the screws were activated for a few millimeters or more to check the correctness of the maxillary movement and to overcome premature bony contacts during the activation process [4,34,[60][61][62]. Mandibular osteotomies, if needed according to the skeletal diagnosis, can be performed in the same operation [59,60,62].…”

Section: Technique and Protocolmentioning

confidence: 99%

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Distraction Osteogenesis in the Treatment of Maxillary Hypoplasia

Olmez-Gurlen¹

2016

Advanced Techniques in Bone Regeneration

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The aim of this chapter is to review literature reporting on the use of internal distraction osteogenesis and rigid external distraction osteogenesis and to determine the biomechanical effects of internal distractors in the treatment of maxillary hypoplasia, especially in patients with cleft lip and palate (CLP), and compare the results with non-cleft patient. The standard osteotomy used for distraction osteogenesis of the hypoplastic maxilla is LeFort I. An advancement of more than 10 mm in patients with no cleft and 6 mm in patients with CLP is beyond the limit of LeFort I osteotomy, and in such cases distraction osteogenesis for advancement of the maxilla can be used. Distraction osteogenesis (DO) is a biological process involving the formation of new bone between viable bone segments that are gradually separated by incremental traction. The external and internal usage of distraction osteogenesis in the treatment of maxillary hypoplasia in patients with cleft lip and palate is a reliable, reproducible and stable alternative method to conventional one-step LeFort I advancement techniques. Biomechanical evaluation of internal maxillary distraction osteogenesis produces mathematical results to help the surgeon and the orthodontist to understand better the therapeutic effects on the maxillofacial bones and sutures of the craniofacial system.

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Computer-Assisted Virtual Planning for Surgical Guide Manufacturing and Internal Distractor Adaptation in the Management of Midface Hypoplasia in Cleft Patients

Scolozzi

Herzog²

2017

The Cleft Palate Craniofacial Journal

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We are reporting the treatment of severe maxillary hypoplasia in two patients with unilateral cleft lip and palate by using a specific approach combining the Le Fort I distraction osteogenesis technique coupled with computer-aided design/computer-aided manufacturing customized surgical guides and internal distractors based on virtual computational planning. This technology allows for the transfer of the virtual planned reconstruction to the operating room by using custom patient-specific implants, surgical splints, surgical cutting guides, and surgical guides to plate or distractor adaptation.

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Maxillary Movement in Distraction Osteogenesis Using Internal Devices in Cleft Palate Patients

Abstract: In the internal distraction technique, the maxilla was advanced inferiorly to the planned vector and with a slight clockwise rotation. These results are useful for surgical planning when using internal distractors.

Cited by 4 publications

References 22 publications

Analysis of Genetic Regulation and Cytokine Expressions of Distraction Osteogenesis Reconstruction for Cleft Palate

Analysis of Genetic Regulation and Cytokine Expressions of Distraction Osteogenesis Reconstruction for Cleft Palate

Distraction Osteogenesis in the Treatment of Maxillary Hypoplasia

Computer-Assisted Virtual Planning for Surgical Guide Manufacturing and Internal Distractor Adaptation in the Management of Midface Hypoplasia in Cleft Patients

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