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Advanced Dental Care 2018: Distraction osteogenesis versus orthognathic surgery - Simon Chummar - NMC Hospital

Abstract

Distraction osteogenesis (DO) initially developed by Ilizarov for limb lengthening has recently been applied to the correction of severe congenital or acquired craniofacial deformities as an early alternative to orthognathic surgery. Distraction osteogenesis involves the lengthening and reshaping of deformed bone by surgical fracture and gradual separation of bony segments. The surgeon lengthens and reshapes deformed bone by surgically fracturing the bone and slowly separating (distracting) the resultant segments with specially fabricated hardware. The bony fragments are held in situ during the primary week following surgical fracture to permit callus to make between the fragments.. During the next several weeks, the fragments are gradually separated at a rate of 1 to 2 millimetres per day, up to a pre-determined length (e.g., 20 days for 20 millimetres or 5/8 inches). The bone segments are moved gradually to permit callus formation and adaptation of fibromuscular attachments. Once the specified length and shape is achieved, the hardware is left in situ for a further 6 weeks until the newly formed bone calcifies. the first advantage claimed in reference to distraction osteogenesis is that it allows major reshaping of the facial bones without bone grafts or jaw wiring. Proponents claim that distraction osteogenesis may be safer than other methods of facial reconstruction, since it can involve less blood loss and a lower risk of infection. Orthognathic surgery is the surgical correction of skeletal anomalies or malformations involving the midface, mandible and maxilla.

Simon Chummar

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