Distraction Osteogenesis In Patients Research Articles

Bone-periosteal-muscle flap for ulnar lengthening in children with congenital radial club hand

Background. Congenital radial club hand is characterized by the underdevelopment of all forearm structures. Ulnar bone shortening ranges from 24.7% to 50.0% compared to the intact limb. The aim of the study was to evaluate the outcomes of ulnar lengthening by distraction osteogenesis in patients with congenital radial club hand type IV who underwent osteotomy with the formation of a bone-periosteal-muscle flap, and to compare these results with the treatment outcomes of the patients who had standard (oblique) ulnar osteotomy. Methods. The main group consisted of 20 patients who underwent osteotomy with the formation of a bone-periosteal-muscle flap during ulnar lengthening between 2019 and 2022. The control group included 19 patients (22 forearms) who underwent oblique ulnar osteotomy between 1998 and 2018. The following indicators were evaluated: length of the regenerate, distraction time, correction period, fixation index, osteosynthesis index, and complications. Results. A lengthening of 4.1 cm was achieved (30.7% of the initial ulnar bone length). The correction of angular deformity was 71.4%. Greater correction was achieved with osteotomy in the proximal ulna. In the subgroup with proximal segment osteotomy, the distraction and osteosynthesis indices were 25.6 and 25.7 days/cm, respectively. In the mid-third osteotomy group, these indices were 42.3 and 42.6 days/cm, respectively. Complications were limited to inflammatory phenomena in 30% of cases. All patients in the main group exhibited successful regenerate formation. Thus, the bone fragment with a periosteal-muscle pedicle serves as an additional source of osteogenesis during distraction. Conclusions. This study demonstrates the appropriateness of osteotomy with the formation of a bone-periosteal-muscle flap in children with congenital radial club hand. This technique allows for greater deformity correction, a shortened regenerate formation period, and a reduction in complications.

Changes of masseter muscle after mandible distraction osteogenesis in patients with Hemifacial microsomia: a retrospective study.

Mandible distraction osteogenesis (MDO) is widely used to reconstruct the mandible in patients with mild Hemifacial microsomia (HFM). However, the masseter's response to mandible distraction remains unclear. In this study, we analyze the effect of the surgical intervention on masseter muscle by a retrospective analysis. The procedure consisted of a five-day latent period, a three-week distraction period, and a six-month consolidation period. CT data were manually segmented and measured with Mimics software before surgery, within 3 months, and more than 1 year postoperatively. Masseter volume, masseter length, masseter width, and mandible ramus height were measured and analyzed using paired t-test, Pearson, and Spearman correlation analysis. We included 21 patients with HFM who underwent mandible distraction osteogenesis from 2015 to 2020. The masseter volume on the affected side increased immediately after surgery from (6,505.33 ± 3,671.95) mm3 to (10,194.60 ± 5638.79) mm3, but decreased to (8,148.38 ± 3,472.57) mm3 at the second follow-up correlated to mandible ramus height (r = 0.395, P = 0.038). A similar trend was observed in changes in masseter length. Symmetry and width of masseter muscle had no longitudinal statistical significance. Masseter muscle involvement benefits from MDO in the short term. To achieve long-term efficacy, more attention should be paid to muscle reconstruction.

Long-Term Orbito-ocular Outcomes Following LeFort III and Monobloc Distraction Osteogenesis in Patients with Syndromic Craniosynostosis.

Exorbitism in patients with syndromic craniosynostosis is often managed by LeFort III (LF3) or Monobloc (MB) distraction osteogenesis (DO). This study compared short- and long-term orbital craniometrics after LF3DO/MBDO and related these findings to symptom relief. Patients undergoing LF3DO or MBDO from 2000-2021 with pre- and postoperative imaging were included. Postoperative CTs were categorized as early (<1 year) or late (>1 year), and age-matched control CTs were compared to late postoperative scans. Superior/inferior orbital rim position, relative globe position, and orbital volume were analyzed. Symptoms were assessed by a patient-reported outcome (PRO) analysis. Thirty-four patients (16 LF3DO, 18 MBDO) were matched by age at surgery, sex, syndrome, and age at imaging. Time to late CT was 6.2 years (LF3DO) and 7.5 years (MBDO). Between early and late postoperative time points, LF3DO patients experienced no change in inferior rim position. MBDO patients experienced a decrease in inferior orbital rim position of 4.7mm (p=0.005), but superior orbital rim distance remained stable. Comparison of late scans and age-matched controls revealed no difference in inferior or superior orbital rim position in LF3DO patients, but the superior orbital rim distance was longer in MBDO patients (p=0.015). PRO response rate was 76% with a median follow up of 13.7 years. Most (81%) symptomatic patients improved, 19% remained symptomatic, and no patients worsened. LF3DO and MBDO achieved stable orbital craniometric changes, with improved stability at the inferior orbital rim after LF3DO. Craniometric changes were associated with long-term exorbitism symptom relief.

Evaluation of simultaneous bilateral femoral distraction osteogenesis with antegrade intramedullary lengthening nails in achondroplasia with rhizomelic short stature: a retrospective study of 15 patients with a minimum follow-up of 2 years.

Bilateral femoral distraction osteogenesis in patients with achondroplasia is insufficiently reported. We aimed to perform the first study that exclusively analyzed simultaneous bilateral femoral distraction osteogenesis with motorized intramedullary lengthening nails via an antegrade approach in patients with achondroplasia focused on reliability, accuracy, precision, and the evolving complications. In this retrospective singlecenter study we analyzed patients with achondroplasia who underwent simultaneous bilateral femoral lengthening with antegrade intramedullary lengthening nails between October 2014 and April 2019. 15 patients (30 femoral segments) of median age 14 years (interquartile range [IQR] 12-15) were available for analysis. The median follow-up was 29 months (IQR 27-37) after nail implantation. The median distraction length per segment was 49 mm (IQR 47-51) with a median distraction index of 1.0 mm/day (IQR 0.9-1.0), and a median consolidation index of 20 days/cm (IQR 17-23). Reliability of the lengthening nails was 97% and their calculated accuracy and precision were 96% and 95%, respectively. The most common complication was temporary restriction of knee range of motion during distraction in 10 of 30 of the lengthened segments. 1 patient was treated with 2 unplanned additional surgeries due to premature consolidation. The method is reliable and accurate with few complications.

EFFECT OF MANDIBULAR DISTRACTION OSTEOGENESIS ON AIRWAY IN PATIENTS WITH TEMPOROMANDIBULAR JOINT ANKYLOSIS

Objectives: The purpose of this study was to clinically and cephalometrically evaluate the pharyngeal airway following mandibular distraction osteogenesis in patients with TMJ ankylosis and retrognathic mandible.&#x0D; Materials and Methods: A total of 10 patients were included in this study. These patients were thoroughly evaluated pre-operatively and post-operatively both clinically and radiologically using McNamara analysis allowing comparison of pre-op and post-op findings.&#x0D; Results: Out of 10 patients seven were females while three were male (Mean age 13.40 ±5.358 SD). Mean pre-operative UPPER airway width was 6.20±3.155 SD as compared to mean Post-operative upper airway (7.30±2.907 SD) with a statistically significant p-value (0.003). Mean pre-operative LOWER airway width was 4.90±1.969 SD as compared to mean Post-operative lower airway (7.10±2.9282 SD) with a statistically non-significant p-value (0.013). There was a negative correlation between post-operative lower airway and age (r= -0.26, sig=0.48).&#x0D; Conclusion: Mandibular distraction Osteogenesis can be used successfully in TMJ ankylosis patients with retrognathic mandible for the improvement of pharyngeal airway dimensions and relief from symptoms of obstructive sleep apnea due to decreased pharyngeal space.

Predicting Outcomes after Mandibular Distraction Osteogenesis in Patients with Isolated Pierre-Robin Sequence

INTRODUCTION: Pierre-Robin Sequence (PRS) is characterized by micrognathia, glossoptosis, and obstructive sleep apnea (OSA). Mandibular distraction osteogenesis (MDO) is a common treatment modality to improve OSA. We aimed to evaluate the sleep study outcomes based on mandibular distraction distance on patients born with OSA secondary to micrognathia. METHODS: A retrospective chart review was conducted for patients with isolated PRS who underwent MDO at Children’s Hospital Los Angeles between January 2006 and September 2021. Relationships between demographics, preoperative sleep variables, and postoperative OSA outcomes were analyzed. Results were stratified according to OSA severity and distraction distance (30 mm vs less than 30 mm). RESULTS: A total of 71 patients met inclusion criteria. Fifty-six patients were distracted to 30 mm, whereas the remaining 15 patients experienced shorter distraction; reasons for shorter distraction included infection, parent preference, and loss to follow-up. Compared with patients distracted to less than 30 mm, those distracted to 30 mm had a significantly greater improvement in AHI when controlling for preoperative sleep study variables (p = 0.047). After MDO, significant improvement was observed in lowest oxygen saturation, AHI, highest carbon dioxide level, and highest oxygen requirement. CONCLUSION: Patients with PRS who have more severe OSA experienced greater improvements in sleep study scores after MDO with more than 89% of patients with severe OSA achieving mild or complete resolution of disease. Our results provide tangible evidence for how distracting patients to 30 mm vs less than 30 mm can improve disease parameters, which can assist clinicians and families in anticipating outcomes after MDO for patients with isolated PRS.

A 3-Dimensional Measurements of Bone and Airway Variables After Le Fort I Distraction Osteogenesis in Patients With Cleft Lip and/or Palate-Induced Midface Hypoplasia: A Retrospective Study.

The authors retrospectively analyzed the effects of Le Fort I advancement with distraction osteogenesis on skeletal and airway variables in patients with midfacial hypoplasia induced by cleft lip and/or palate using 3-dimensional computed tomography reconstructions. The authors enrolled 23 subjects with moderate-to-severe midface hypoplasia induced by cleft lip and palate who were treated with Le Fort I distraction osteogenesis (mean age, 19.22±3.48y; male/female ratio, 20/3); computed tomography images (1 before distraction and another at completion of distraction) were acquired. A 3-dimensional craniometric findings and airway volumes for the nasal cavity, nasopharynx, velopharynx, and upper and lower oropharynx were compared before and after distraction. The relationships between craniofacial morphology and changes in airway volume were also assessed ( P <0.05 was considered significant). Significant increases were observed in airway volumes for the nasal cavity (13.85%), nasopharynx (50.82%), velopharynx (29.57%), and upper oropharynx (36.92%) ( P =0.007, P <0.001, P =0.023, and P <0.001, respectively), whereas no significant changes were observed for the lower oropharynx ( P =0.117). Maxillary horizontal advancement was positively correlated with the airway volumes of the nasopharynx and upper oropharynx after distraction osteogenesis ( rs =+0.451, P =0.031; rs =+0.548, P =0.007); however, no significant correlations were observed for the nasal cavity and velopharynx. The authors' finding indicate that despite rotation of the mandible along with the maxilla, this change does not impact airway volume at the mandibular level. Le Fort I distraction osteogenesis can be feasible for patients with cleft lip and palate-induced midface hypoplasia, with satisfactory appearance and occlusion. Long-term detailed follow-up of the patients postdistraction osteogenesis is warranted.

Maxillomandibular Development After Mandibular Distraction Osteogenesis in Patients With Isolated Pierre Robin Sequence: A Quarter Century Review

Mandibular distraction osteogenesis (MDO) is an effective treatment for obstructive sleep apnea (OSA) in infants with microretrognathia1; this is particularly beneficial for patients with isolated Pierre Robin sequence (iPRS). Without intervention to improve the upper airway, patients may require tracheostomy. It is generally accepted that these patients develop with disproportionate maxillomandibular growth postdistraction; yet, the timeline for relapse to class II and differences across sexes are not well-described.

Predicting Outcomes Following Mandibular Distraction Osteogenesis in Patients With Isolated Pierre-Robin Sequence

Pierre Robin sequence (PRS) is characterized by micrognathia, glossoptosis, and obstructive sleep apnea (OSA). MDO has become a well-documented and effective surgical modality to treat OSA and avoid tracheostomy.1,2 The overall benefits of MDO for patients with PRS are well-described in the literature. The effect of distraction distance has not been investigated. The authors sought to elucidate the patient and distraction factors that affect postoperative outcomes for these patients. A retrospective chart review was conducted for patients with isolated PRS who underwent MDO at Children's Hospital Los Angeles between January 2006 to September 2021.

Early cranial vault distraction for a more balanced and enhanced expansion: a 3D craniometric analysis of anterior versus posterior distraction osteogenesis in patients with craniosynostosis.

Posterior distraction osteogenesis (DO) is widely accepted for the treatment of craniosynostosis. The aim of this study was to quantitatively compare the effect of DO on the cranial vault according to the age of the patient and direction of distraction. This was a retrospective study of patients with craniosynostosis who underwent DO in the anteroposterior direction. Postdistraction changes in intracranial volume (ICV), anteroposterior distance, biparietal distance, cranial height, and frontal bossing angle were measured using Mimics software on CT scans. Craniometric data were analyzed using a multivariate regression model. Thirty-two patients (16 anterior and 16 posterior DOs) were included in the study. The mean ICV increase in the anterior and posterior DO group was 211 cm3 (range 142-281 cm3) and 214 cm3 (range 150-279 cm3), respectively. Patients who were aged 1 year or younger showed a greater percentage increase in ICV than patients older than 1 year. In the anterior DO group, a more balanced increase in both anterior and posterior anteroposterior distance was observed in patients aged 1 year or younger when compared to patients older than 1 year. In the posterior DO group, a bigger expansion and smoother contour in the posterior cranial fossa was observed in patients aged 1 year or younger. Both anterior and posterior DO are effective surgical options for expanding the cranial vault in patients with craniosynostosis. Early distraction appeared to show greater morphological changes in the growing cranial vault than those predicted with the vector of distraction.

Polysomnography-guided mandibular distraction osteogenesis in Pierre Robin sequence patients.

Craniofacial malformations with micrognathia cause high grades of obstructive sleep apnea (OSA) measured by polysomnography (PSG). Mandibular distraction osteogenesis is a novel procedure for upper airway obstruction relief. Our primary objective was to describe the utilization of PSGs to improve obstruction in patients undergoing mandibular distraction. This is a retrospective study. Patients with micrognathia and severe upper airway obstruction, presenting with severe OSA diagnosed by PSG, were included from a single tertiary care center between 2015 and 2019. PSGs were done (1) prior to surgery, (2) once the cosmetic goal was achieved (Post-Op 1), and (3) if residual moderate-to-severe OSA was seen, every 2 nights until mild or no OSA was achieved (Post-Op 2). Thirteen patients were included. The median age at surgery was 1.1 months (10 days-3 months). All 13 patients had baseline severe OSA, with a median obstructive apnea-hypopnea index of 33 events/h and a median O2 nadir of 73%. Post-Op 1 PSG was done at a median of 6 days after surgery. Median first postoperative obstructive apnea-hypopnea index in all 13 patients was 6.8 events/h, with a median O2 nadir of 87%. A median additional distraction of 3 mm was needed beyond the traditionally recommended advancement. Long-term follow-up studies at or after 1 year were done in 5 patients, all showing persistent nonsevere OSA. This is the first case series utilizing PSGs as a guide for mandibular distraction osteogenesis in patients with micrognathia showing the need for jaw overcorrection to achieve resolution of OSA. Kochhar R, Modi V, de Silva N, etal. Polysomnography-guided mandibular distraction osteogenesis in Pierre Robin sequence patients. J Clin Sleep Med. 2022;18(7):1749-1755.

Facial Nerve Dysfunction After Mandibular Distraction Osteogenesis in Patients with Robin Sequence: A Systematic Review and Meta-Analysis.

Robin Sequence (RS), characterized by micrognathia, glossoptosis, and upper airway obstruction, is an increasingly recognized diagnosis. An effective surgical intervention is mandibular distraction osteogenesis (MDO). This study analyzes published evidence regarding facial nerve dysfunction (FND) associated with MDO. According to PRISMA guidelines, a systematic review was carried out with databases queried in June 2019 using MESH terms, or equivalent terms, as follows: "distraction osteogenesis" and "Robin Sequence". A review of original Spanish and English articles, were included. Outcome measures included the prevalence of FND; the affected branches; the rate of permanent vs. transient FND; the use of an internal vs. external device; the daily distraction rate; and finally, the overall distraction length. Subsequently, a meta-analysis was conducted to collate results regarding the prevalence of FND and the factors associated with it. Of 239 unique studies identified, 19 studies with 729 patients met inclusion criteria; 52 patients developed FND after MDO. A random-effects meta-analysis yielded a pooled prevalence of FND of 6.40%, with moderately heterogeneous studies (I2 = 41%, τ2 = 0.006). Marginal mandibular nerve involvement was most commonly noted. Nine studies reported transient FND, six permanent, one both, and two unspecified. Internal distractors were used in 8 studies and external in 3 and both in 2. Distraction rate was 1.00 to 2.00 mm/day and total distraction length ranged from 13.00 to 22.3 mm. Sample size was the only parameter inversely associated with rate of FND (p = 0.04). This analysis of FND associated with MDO for patients with RS demonstrates a lack of consistent documentation. MDO-associated FND does not appear to be uncommon, and permanent dysfunction can occur. This review underscores the importance of thorough documentation to elucidate the mechanism of FND.

Alveolar distraction osteogenesis: possible complications and methods of their treatment

The aim of the study. Analysis of emerging complications during the method of alveolar distraction osteogenesis in patients with jaw defects. A retrospective analysis of foreign and domestic literature was carried out. A systematic literary search was carried out in the electronic bibliographic databases Web of Science (for foreign articles) and Elibrary and Dissercat (for domestic). In the period from 2005 to 2019 in the clinic of the Department of Maxillofacial and Plastic Surgery of the Moscow State Medical University. Evdokimov conducted an examination and comprehensive treatment of 490 patients with primary and secondary adentia of the upper and lower jaws, accompanied by a significant deficiency of bone tissue of the alveolar ridge vertically. A comprehensive dental rehabilitation of patients with jaw defects by the method of distraction osteogenesis was carried out. The most common complications are: exposure of the fixation modules of the distraction apparatus - 24% of cases, failure of bone regenerate - 13%, inflammatory phenomena - 13%, displacement of the distraction vector - 43%, paresthesia - 7%. Based on our analysis of the identified complications during the distraction osteogenesis method, it was found that these complications are not critical in the treatment of patients with jaw bone deficiency and do not jeopardize the success of rehabilitation. With diagnosis and timely approach to treatment, complications are avoidable.

Plasty of shin bone defects with segmental loss using ring fixators of the wire-rod type

The problem of segmental bone loss of the tibia after fractures is an urgent and not completely resolved problem. The use of distraction osteogenesis by bone transport according to Ilizarov is the leading method of treatment. Improving this technology is a generally accepted way of improving treatment outcomes.To propose improvements in the technology of distraction osteosynthesis with the use of ring fixators, taking into account the problematic issues of their use; analyze the results obtained.Tasks: to formulate the disadvantages and problematic issues of distraction osteogenesis in patients with segmental defects of the leg bones after fractures; to propose a solution to the existing disadvantages of the method; analyze the results.78 victims met the inclusion criteria. 36 patients were operated on according to the proposed method; they made up the core group; 42 – comparison group, treatment was carried out according to the generally accepted method. The time spent in the external fixation apparatus and the index of external fixation were used as criteria for evaluating the results; the final assessment was carried out according to the anatomical and functional scale Modified Functional Evaluation System by Karlstrom–Olerud.Our results (good and excellent 77.8 %; unsatisfactory in 2.8 % are comparable to those of most researchers. Anatomical and functional results in the main group with a high degree of probability (˃95 %) exceeded the results in the comparison group.Bearing in mind the severity of the defeat, we find this result encouraging. Given the insufficient number of observations, it is necessary to recommend the use of the proposed improvements in the use of RF in the treatment of nonunions of the shin bones after fractures and further study of their effectiveness.Thus, nonunion of the tibia requires complex treatment using osteosynthesis with ring fixators. Spoke-rod designs of the apparatus, gentle technique, optimal ways of guiding the pins, transition to final fixation using Softcast/Scotchcast systems, drug correction of regeneration disorders made it possible to avoid many complications of extrafocal fixation and obtain good results.

Fronto-Orbital Advancement and Posterior Cranial Vault Expansion Using Distraction Osteogenesis in Patients With Multiple Craniosynostosis.

This study aimed to evaluate the treatment outcomes and the efficiency of techniques of fronto-orbital advancement (FOA) and posterior cranial vault expansion (PCVE) using distraction osteogenesis in patients with multiple craniosynostosis. We assessed the treatment results and outcomes of 8 patients with multiple craniosynostosis at the Kagoshima University Hospital between 2005 and 2019. Each 4 patients underwent FOA and PCVE, respectively, using distraction osteogenesis. The cranial volume and developmental quotient (DQ) were measured at the preoperative period and 1 year after surgery. The mean patient age at surgery was 22 months. The mean preoperative cranial volume was 1027 and 1071 cm3 in the FOA and PCVE groups, respectively. The mean preoperative DQ scores were 74 and 67, respectively. After 1-year of follow-up, the corresponding mean cranial volume became 1108 and 1243 cm3, respectively. The corresponding mean DQ scores also improved to 74 and 81, respectively. The postoperative follow-ups in all cases were uneventful, except for persistent epilepsy in 1 patient. Fronto-orbital advancement and PCVE using distraction osteogenesis might contribute to good outcomes in expanding cranial volume, cosmetic osteogenesis, and infantile development in patients with multiple craniosynostosis. Regarding the cranial volume expansion, especially, PCVE using distraction osteogenesis is more effective than FOA.

Mandible customized distraction osteogenesis in Treacher Collins patient: Literature review, report of a case and post-distraction analysis

IntroductionTreacher-Collins syndrome is a rare genetic disorder with variable phenotypic expression. Related micrognathia can cause upper airway obstruction in neonatal patients because of posterior tongue displacement. Many approaches have been described to treat upper airway obstruction in such patients; the use of mandibular distraction to this purpose was first proposed in 1994. To our knowledge, only a few authors have employed customized devices to perform mandibular distraction in these syndromic patients.This paper presents a systematic review of the use of customized devices to perform mandibular distraction osteogenesis in patients affected by Treacher-Collins syndrome and upper airway obstruction. A case report of a Treacher-Collins syndrome patient treated in our institution is also presented. ResultsEight articles fulfilled the inclusion criteria and were included in this systematic review; demographic, clinical and surgical features of 13 cases were evaluated.Preoperative assessment, virtual surgical planning and a surgical protocol for a Treacher-Collins patient were performed and set-out in detail; a post-distraction 3D analysis workflow was developed and proposed.The patient had an airway obstruction resolution after the distractors removal and was progressively decannulated. The post-distraction 3D analysis revealed that the oropharynx and hypopharynx airway space acquired greater volumetric dimension in a more antero-superior position; this advancement was comparable to the antero-superior advancement of the distracted mandible. ConclusionIn the author’s opinion, customized devices for mandibular distraction osteogenesis and post-distraction tridimensional analysis should be objected of further investigation in the light of their potential advantage in diagnosis and treatment of syndromic malformation.

The Evaluation of the Radiological and Functional Outcome of Distraction Osteogenesis in Patients with Infected Gap Nonunions of Tibia Treated by Bone Transport.

AIM:The aims of this investigation were: 1) to study the Functional outcome of performing distraction osteogenesis in cases of infected non-union of tibia treated with Ilizarov and Limb Reconstruction System, and 2) to study the Radiological outcome of performing distraction osteogenesis in cases of infected non-union of tibia treated with Ilizarov and Limb Reconstruction System.METHODS:The study was done with 27 patients of infected gap nonunions of the tibia at Sir JJ Hospitals, Mumbai from 2013-2016. After implant removal, if required radical resection of necrotic tissue and fractures were stabilised with Ilizarov or mono-lateral fixator depending on non-union site. Corticotomy was either done proximally or distally. Patients were followed up at monthly intervals for a minimum of 6 months.RESULTS:The ASAMI-Bone healing score was Excellent or Good in 86% patients, and Functional score was Excellent or Good in 89% of patients. The commonest problems were of pin tract infection, wire loosening and angulation of the transported segment.CONCLUSION:Elderly age, persistent infection, sensory loss in the foot, the stiffness of the knee, and above all the patient’s reluctance to go any further given the protracted treatment besides, systemic disorders such as diabetes are all pointers for considering amputation as an alternative.

Midface correction in patients with Crouzon syndrome is Le Fort III distraction osteogenesis with a rigid external distraction device the gold standard?

IntroductionLe Fort III distraction osteogenesis with a rigid external distraction device is a powerful procedure to correct both exorbitism and impaired airways in faciocraniosynostosis. The aim of this study was to investigate treatment effect, perioperative parameters and volumetric outcomes after Le Fort III distraction osteogenesis in patients with Crouzon syndrome in a retrospective study design and to explore potential strengths and weaknesses of this procedure. Materials and methodsFrom June 2013 to February 2015, a total of nine children with Crouzon syndrome underwent Le Fort III distraction osteogenesis with a rigid external distraction device (RED device, KLS Martin, Tuttlingen, Germany). Along with perioperative parameters, sleep study reports, traditional cephalometric analysis, three-dimensional imaging and photographs were evaluated for severity of disease and therapeutic effect and structural and functional changes of the upper airway preoperatively, after device removal and one year postoperatively. ResultsSurgery for Le Fort III distraction was performed at a median age of 12.5 years (SD 2.5 months) with an average weight of 43.0 kg (SD 12.9 kg). Mean estimated blood loss was 535.7 ml (SD 128.1 ml), not requiring any red blood cell transfusions. Mean duration of surgery was 240 min (SD 30.6min), average hospital stay eight days (SD 0.5 days) with a planned median ICU stay of 1.7 days (SD 0.4 days) for all patients.There were a total of five minor complications. Exorbitism and Angle class III malocclusions were corrected in all patients. No patient showed velopharyngeal problems postoperatively. The average amount of distraction was 18.4 mm (14–26 mm). Average length of the distraction period was 18.3 days (SD 0.4 days), with a total distraction plus consolidation time of three months (SD 0.25 months). In two patients, vector correction was performed during distraction. A counterclockwise movement despite vector correction, clinically resulting in an open bite, was observed in one of these two patients. Eight of the nine patients showed a frontal overbite at the end of the distraction period.Cephalometric analysis revealed a significant increase of Sella-Nasion-Point A angle (SNA) from 76.0° (+/− 2.9; T1) to 86.0° (+/− 3.4; T2) (p = 0.006) and growth-related point A-Nasion-point B angle (ANB) from −4.8° (+/−3.7) to 5.7° (+/−4.8) (p = 0.001) from preoperatively to device removal and stable results one year postoperatively.Upper airway structure and respiratory function were improved clinically after the Le Fort III DO treatment in all cases with an average posterior airway space increase from 3199 mm3 (+/− 229.6 mm3) to 8917,7 ml (+/−415.1 mm3) (T1 to T2).Surgical outcome was judged good to excellent both by patients and families and the craniofacial team. ConclusionLe Fort III DO with a rigid external distraction device in patients with Crouzon syndrome is a powerful and reliable surgical procedure that reliably produces a more significant change of appearance than most other single procedures routinely performed by craniofacial surgeons. It effectively treated sleep apnea in the affected patients. In our collective, the maxilla remained stable after advancement without any relapse, but there was no subsequent anterior growth on one year follow-up. Careful vector planning was able to avoid frontal open bite in eight patients. Complication rates were acceptably low and patients’ functional and esthetic outcome was high.

Effect of distraction osteogenesis in patient with tibial shortening after initial union of congenital pseudarthrosis of the tibia (CPT)

Background: This is a Retrospective study which was conducted with the purpose of evaluating the preliminary result of distraction osteogenesis in patients with tibial shortening after initial union of Congenital Pseudarthrosis of the Tibia (CPT). Methods: Identification of all the CPT cases with tibial shortening after initial union managed by proximal tibia lengthening using Ilizarov technique was done. All the patients charts and radiograms were reviewed. Results: 11 CPT cases were included between March 2013 and January 2018 with an average follow up of 41 months (range, 34-51 months). 8.5 years was the mean age at surgery. The average length of discrepancy was 5.6 cm (range, 2.0-8.2 cm). Radiological findings of proximal tibial dysplasia were found in eight cases while three other cases had no radiological findings. The average distraction length gained was 5.3cm (range, 3.5 -8.0 cm) with a mean elongation rate of 21.4% (range, 15-30%). The Healing Index (HI) was 63.1 d/cm (range, 47–77 d/cm). The Findings seen in the eight patients with proximal tibial dysplasia was that out of eight cases, five cases had lateral callus, three had central callus and poor bone regeneration was seen in all of them. In the three patients who had no radiological findings concave shaped callus was identified with an average HI of 52.7 d/cm. None of the patients had refracture, non-union, axis deviation or angulation of the distraction area. Two of the patients were found to have ankle stiffness. There was no evidence of knee contracture in any of the patients. There were five cases with pin tract infection which was managed by regular dressing and oral antibiotics. Conclusions: We concluded that proximal tibial lengthening after initial union of CPT was effective for management of tibial shortening, however poor bone regeneration with various types of callus from normal, greater healing index and prolonged fixator wearing was seen. We recommended that when the limb length discrepancy (LLD) was more than 4 cm in younger children after primary union of CPT, tibia lengthening could be considered.

Change in the posterior airway after mandibular distraction osteogenesis in patients with ankylosis of the temporomandibular joint: a retrospective study

Mandibular distraction osteogenesis (DO) has been shown to lead to considerable improvement in obstruction of the posterior airway space in patients with ankylosis of the temporomandibular joint (TMJ), and our objective was to find out if we could confirm these findings. Seventeen patients had spiral computed tomographic (CT) scans before and after DO. After treatment, the overall posterior airway space was enlarged in all three sections of the airway (oropharyngeal, glossopharyngeal, and laryngeal). We then compared rates of change in the airway among the sections using 2-dimensional and 3-dimensional assessments, and found that the rate of change in 3-dimensional assessment of volume was significantly higher than that in the 2-dimensional (62% compared with 34%). We also found that the higher 3-dimensional rate of change came from changes in the oropharyngeal and glossopharyngeal sections, while there was no significant difference between the 2- and 3-dimensional rates of change in the laryngeal section. Because the laryngeal section had the most robust enlargement after DO in both the overall area of the posterior airway space (increased by 54%) and volume (increased by 73%), we concluded that 3-dimensional assessments were more sensitive to smaller changes in the airway space during the operation. This suggests that 3-dimensional assessments are preferable in the prediction and evaluation of the effects of DO on the posterior airway space.