Sutural Distraction Osteogenesis (SDO) Versus Osteotomy Distraction Osteogenesis (ODO) for Midfacial Advancement: A New Technique and Primary Clinical Report

Abstract

A new technique of osteotomy distraction osteogenesis (ODO) and sutural distraction osteogenesis (SDO) by the use of bone-borne traction hooks is presented. The technique of osteotomy plus distraction osteogenesis is suitable for adult patients. The technique of sutural distraction osteogenesis is suitable for young patients, ages 6 through 12 years. The distraction system consists of a face-bow, orthodontic elastics, and bone-borne traction hooks. The bone-borne traction hooks are made of titanium, with two traction hooks running laterally or downwardly. When a Le Fort III osteotomy is needed, bone-borne traction hooks are inserted through the nostrils into a bone hole drilled at the lateral-inferior pyriform aperture. When no osteotomy is needed, only the bone-borne traction hooks are placed. Heavy elastics were used in the technique of osteotomy distraction osteogenesis for Le Fort III osteotomy adult patients, whereas light forces and thus light elastics were used for younger patients. Three adult patients and four children were treated by osteotomy distraction and sutural distraction, respectively. All seven patients with midfacial hypoplasia established a harmonious facial profile and normal occlusal relationships. Radiographic examination showed balanced advancement of the midfacial skeleton. It is suggested that the treatment of midfacial hypoplasia in children by the technique of sutural distraction osteogenesis is to be preferred because of its simplicity and relative noninvasiveness. Thus, the authors suggest that midfacial hypoplasia should be treated at a younger age by this technique, potentially eliminating the need for a Le Fort III osteotomy at an older age.

Effects of Platelet-Rich Plasma and Recombinant Human Bone Morphogenetic Protein-2 on Suture Distraction Osteogenesis

“…2,3,15Y18 There are also some studies dealing with other craniofacial sutures. 1,19,20 These studies show that distraction through craniofacial sutures without osteotomy can play a major role in the management of problems related to craniofacial bone defects. The clinical application of this treatment approach has, however, been hampered by a long retention period and a high relapse tendency.…”

Advancement of the midface, from conventional Le Fort III osteotomy to Le Fort III distraction: review of the literature

“…Trials have been undertaken to limit incisions by using an endoscopic approach 53 and to lower morbidity by using ultrasound osteotomes in craniofacial surgery 5 . Following experimental animal studies by STAFFENBERG et al 84 and MCCARTHY 61 , PELLERIN et al 71 and LIU et al 54 performed midface advancement in children aged 6-12 years by applying distraction force to the midface with a midfacial pin but without osteotomy. Computer-aided surgical simulation is now being used in the fully virtual pre-operative planning of complex mid-facial deformities 30 .…”

“…With only bony anchorage paranasally, at the aperture piriformis and in the zygomatic region the mobilized segment can be brought forward successfully (Fig. 4) 51,54,59 . In order to minimize halo-related complications with external distractors, the authors advise taking a CT scan of the cranium preoperatively to detect any possible bony defects 68 .…”

Three-dimensional quantitative evaluation of midfacial skeletal changes after trans-sutural distraction osteogenesis for midfacial hypoplasia in growing patients with cleft lip and palate

“…The early treatment options for midfacial hypoplasia mainly include distraction osteogenesis (DO) with Le Fort osteotomy (Scolozzi, 2008) and trans-sutural distraction osteogenesis (TSDO) (Liu et al, 2005;Tong et al, 2015), which both progressively advance the skeleton in association with the expansion of the surrounding soft tissue. TSDO has been proved to have the advantage of achieving the advancement of midfacial skeleton by applying force to the immature circummaxillary sutures while successfully avoiding the risk of Le Fort osteotomy in some way, but there is still lack of recognition of the mechanism of the TSDO in growing CLP patients.…”