Rotating Distraction Osteogenesis in a Child with Secondary Craniosyntostosis

Abstract

The purpose of the treatment of mandibular fractures is to restore proper dental occlusion and stable temporomandibular joint movement, as well as the reduction of the displaced fracture. Consideration must be given to the selection of the most appropriate surgical and rehabilitation methods in such patients. Typical surgical methods for the treatment of mandibular fractures include the arch bar method or plating at the location of the fracture combined with fixing the mandible to the maxilla using the arch bar method. However arch bars and circumdental wires, which require teeth for fixation, damage teeth and periodontal tissue, and tend to be uncomfortable for patients during the fixation period. Moreover, daily maintenance of oral hygiene is difficult for patients with an arch bar. Surgeons are also exposed to the risk of blood-transmitted diseases through skin punctures by wires when affixing these devices. For these reasons, we chose to study the potential of the MMFS method, which is thought to lessen all of the following problems: tissue damage, operating time, patient discomfort, and possible exposure to percutaneous infectious disease due to puncture of gloves and skin by the wires. We demonstrated the utility of the MMFS method in the present study.T he restoration of proper dental occlusion is important in the treatment of a mandibular fracture. The arch bar method is generally used to treat such fractures at present. However, both teeth and periodontal tissue are damaged by penetration of and ligation with the more than 10 wires required by this procedure. The operating team is also placed at considerable risk due to the potential for the ends of the wires to puncture gloves and/or fingers. We analyzed the potential for use of a treatment in which screws are inserted into the maxilla and mandible, and are then ligated with wires to fix both the maxilla and mandible in place and avoid the aforementi1d problems. Fifteen patients with mandibular fractures were treated with maxillomandibular fixation screws (the MMFS method) at the Izunagaoka Hospital of Juntendo University from April, 2000 to December, 2001. Proper dental occlusion was achieved in all patients treated using the MMFS method, and normal temporomandibular joint function was restored after rehabilitation. However, paresthesia occurred around the symphysis menti of the mandible in 33.3% of the patients. The MMFS method proved to be a reliable surgical method for the treatment of mandibular fractures. It not only restores proper dental occlusion and natural temporomandibular joint function, but it also offers the advantages of increased ease of oral and dental hygienic maintenance as well as decreased dental damage, operating time and risk of puncturing gloves and skin. PATIENTS AND METHODSA retrospective chart review was conducted on 15 patients with mandibular fractures treated by the MMFS method at the Izunagaoka Hospital of Juntendo University from April, 2000 to December, 2001. The mean age of the 15 patients was 23.3 years. T...

Cranial vault expansion by distraction osteogenesis

“…The disadvantages of distraction osteogenesis are significant but are heavily outweighed by its many advantages. 1,7,10,22,27 Earlier surgery in many of our patients would, in retrospect, have been better, particularly in those with papilledema. In 20 of the patients in this series, there was convincing evidence of intracranial hypertension, but we did not require the presence of papilledema for this determination.…”

“…59 Multivectoral distraction can be accomplished with the external device used in our Case 18 (second procedure). Chung and Yoon reported a technique for rotating a forehead flap as it is being translated, 10 and Nishimoto et al used distracters with hinge plates in combination with a "floating forehead" technique. 41,42 Anderson et al used two sets of distracters to simultaneously transpose bone fragments along 2 different vectors.…”

“…The mandatory unidirectional expansion has been commonly cited as a shortcoming; however, some devices and techniques have partially addressed this issue. 10,42,59 A second surgical procedure is required to remove the distracters and, although in itself is a disadvantage, this provides an opportunity to address unwanted osseous ridges or other irregularities. 9 Also canthopexies and scars can be addressed at this time.…”

Distractor Breakage in Cranial Distraction Osteogenesis for Children with Craniosynostosis

“…We performed a rotating distraction osteogenesis of the bilateral frontal and the orbital bar with a standard fronto-orbital osteotomy after a bicoronal skin incision [13]. We resected a piece of free frontal bone flap 1 cm above the orbital rim with a pneumatic cranial drill and saw.…”

“…Recently, the simple technique of using only one or two distractors was introduced with cosmetic and economic advantages [4, 6, 13, 14]. We encountered 2 cases of device breakage with the new method of craniofacial distraction using one or two distractors.…”