Role of distraction osteogenesis in craniomaxillofacial surgery

Abstract

In the field of orthopedic surgery, distraction osteogenesis (DO) is well known for limb lengthening procedures or secondary corrective surgery in the fracture treatment of the extremities. The principle of gradual expansion of bone and surrounding soft tissues as originally described by G.A. Ilizarov is also applicable to the craniofacial skeleton when growth deficiency is present, and the patients affected by craniofacial or dentofacial anomalies may require distraction procedures. The surgical management is comparable. After osteotomy and the mounting of a specific craniomaxillofacial distraction device, active distraction is started after a latency phase of several days, with a distraction rate of up to 1 mm/day until the desired amount of distraction has been achieved. Subsequently, distractors are locked to provide appropriate stability within the distraction zone for callus mineralization during the consolidation phase of 3–6 months, which is followed by a further remodeling of the bony regenerate. After 14 years of clinical application, the role and significance of craniomaxillofacial DO are discussed after reviewing the files of all patients who were treated by craniomaxillofacial distraction procedures.

International recognition of the Ilizarov bone reconstruction techniques: Current practice and research (dedicated to 100thbirthday of G. A. Ilizarov)

“…It was applied for traumatic skull defects and brain vascularity stimulation after brain stroke but the techniques remained on the stage of uncompleted clinical trials. On the contrary, the role and significance of craniomaxillofacial distraction procedures have been much discussed in the specialized literature and has been found applicable in craniofacial deficiency or dentofacial anomalies that are corrected with distraction procedures and special devices[ 132 , 133 ]. Another Ilizarov’s idea of stimulating the vascularity in chronic ischemic diseases in the lower extremities has been revived and its modification has been called tibial transverse distraction[ 134 , 135 ].…”

Complications of Surgically Assisted Rapid Maxillary/Palatal Expansion (SARME/SARPE)—A Retrospective Analysis of 185 Cases Treated at a Single Center

“…The biological phenomenon of distraction osteogenesis used in this process 2 of 18 was first described by Codiville in 1905. In the mid-twentieth century, bone distraction was popularized and modernized by the Soviet orthopedist Ilizarov [8].…”

Inflammatory macrophages facilitate mechanical stress-induced osteogenesis

“…DO is efficacious for reconstructing bony defects, whereas the underlying molecular biology and biology of bone development remain poorly understood [5]. So far, it is believed that mechanical stimulation by DO induces a biological response of new bone regeneration that is accomplished by a cascade of biologic processes including differentiation of pluripotential cells, tissue angiogenesis and mineralization, as well as remodeling in the damaged region [6]. The most important remaining question is how the distraction-induced mechanical forces are translated into biologic signals to induce new bone regeneration.…”