The Versatility of Distraction Osteogenesis in Craniofacial Surgery

Abstract

To review our preliminary results using distraction osteogenesis for the correction of craniofacial deformities and to determine its role in treating anatomic deformities and functional deficits relative to conventional craniofacial surgery. Retrospective clinical review; tertiary care center. Twenty-four consecutive patients were treated with distraction osteogenesis during a 34-month period. Outcomes were compared with preexisting anatomic deformities and functional deficits using records of clinical assessments, photodocumentation, diagnostic imaging, and treatment planning aids. Distraction achieved vs planned distraction based on clinical and radiographic assessment, clinical status of functional deficits before and after treatment, and objective rating of aesthetic improvement. Preliminary results demonstrated good-to-excellent outcome in correcting facial skeletal deformity in 80% of patients. Functional outcomes included resolution or significant improvement of upper airway obstruction in 13 of 14 patients and correction of corneal exposure for all 5 patients with preexisting exorbitism. Correction of malocclusion was less reliable. Problems related to the distraction devices, including failure of the advancement mechanism and fixation, were the most prevalent complications. Distraction osteogenesis represents an exciting new development in craniofacial surgery with several potential benefits, including less invasive surgery, the ability for earlier intervention, and the potential for correction of more severe deformities with improved posttreatment stability. The exact role of distraction osteogenesis relative to conventional techniques requires ongoing assessment.