Abstract
The techniques and procedures involved in craniofacial distraction are constantly evolving. The understanding of histological and biochemical response at the distraction site is now improved. The cascade of events in distraction osteogenesis (DO) differs significantly from the typical fracture healing, and a better knowledge about these events has helped us identify suitable candidates for DO, make appropriate modifications to the distraction protocols and minimize the risk of complications. Recent advances in the manufacturing techniques have also facilitated the availability of distractors of various shapes and designs, which are now changing the way different craniofacial defects are being treated. Small but rigid intraoral distractors now enable easy placement, are well tolerated by patients and allow for a long consolidation period. The introduction of newer approaches toward treatment, together with the simultaneous management of different craniofacial defects at multiple osteotomy sites and enhanced surgical accuracy with the help of digital imaging, have made treatment outcomes more predictable.
Highlights
Distraction osteogenesis (DO) is a well-established technique in the field of orthopedics, as it has been used for several decades for limb lengthening and the repair of long-bone defects
The standard protocol of distraction osteogenesis (DO) is based on careful planning, with special attention being paid to the anatomy and blood supply of the osteotomy site, the patient’s general health, and the design and mechanical properties of the distraction device
Kocyigit et al investigated the effects of ultra sound stimulation (LIPUS) and laser therapy (LLLT) on the bone mineral density (BMD) of the bone formed during DO with the use of dual energy X-ray absorptiometry.[72]
Summary
Distraction osteogenesis (DO) is a well-established technique in the field of orthopedics, as it has been used for several decades for limb lengthening and the repair of long-bone defects. Kocyigit et al investigated the effects of ultra sound stimulation (LIPUS) and laser therapy (LLLT) on the BMD of the bone formed during DO with the use of dual energy X-ray absorptiometry.[72] Both methods showed improvement in healing after DO and greater BMD in the exposed groups (LIPUS or LLLT) as compared to the controls.[72]. The following are the basic guidelines for 3D-based DO and the fabrication of the surgical stent (Fig. 6): – data acquisition: 3D imaging techniques, such as conebeam computed tomography (CBCT), computed tomo graphy (CT), magnetic resonance imaging (MRI), etc., have been used for data acquisition; these, along with the virtual models, are correlated on a common Cartesian system to construct a 3D model; – data analysis and the determination of skeletal discrepancy: the exact skeletal discrepancy in all planes is computed using the 3D model; based on this, the exact amount and direction of movement of the bony segment is determined; – determination of the position and angulation of the distractor: the vector is one of the significant factors for the achievement of the planned movement; this vector is determined by the position and angulation of the device on the bony segment, and the type of distractor used. This stent is used to transfer the planned surgery to the operating room
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