Feasibility of Mandibular Distraction Osteogenesis Using Mixed Reality-based Dynamic Navigation: A Preclinical Study.

X-linked hypophosphatemic rickets (XLHR) is caused by loss-of-function mutations in the phosphate-regulating endopeptidase homolog X-linked gene (PHEX). Secondary craniosynostosis is one of the complications of XLHR. Early fusion of the coronal, frontal, and sagittal sutures was noted at 11 months of age in an infant diagnosed with XLHR. A fronto-orbital distraction was performed at 14 months of age to increase cranial morphology and intracranial volume. Although the surgical approach utilized distraction osteogenesis, a fronto-orbital fragment was first removed, reshaped, and then a fronto-orbital distraction was performed due to the extensive fusion of the cranial sutures and significant deformity. Postoperatively, new bone formation took somewhat longer than expected due to the nature of the disease. However, bone formed without major issues, the cranial cavity expanded significantly, and a favorable cranial morphology was achieved. Distraction osteogenesis is a more reliable technique because tissue is progressively stretched with a gradual extension of soft tissue as well. Distraction osteogenesis remains an effective treatment option even for craniosynostosis caused by bone disorders like XLHR.

To compare the clinical and radiological outcomes of the computer assisted octopod external fixator [Adam Frame (AF)] and the conventional Ilizarov external fixator (IEF) in pediatric and adolescent patients undergoing lower limb deformity correction and lengthening. This retrospective comparative study included 48 patients (< 18years, 69 extremities) treated between 2009 and 2015 at two tertiary orthopedic centers. Patients were divided into AF (25 patients, 35 extremities) and IEF (23 patients, 34 extremities) groups. Demographic data, deformity characteristics, correction parameters, indices, and complications were analyzed. Primary outcomes included correction angles, external fixation indices, and complication rates. The mean age at surgery was 12.0years in both groups (AF range 9-14, IEF range 5-14; p = 0.309). Sex distribution was also similar (AF: 14 males, 11 females; IEF: 13 males, 10 females; p = 1.000). Femoral involvement was more common in the IEF group, while tibial involvement was common in the AF group (p = 0.046). Sagittal plane deformities were more frequent in the AF group (34.29% vs. 5.88%; p = 0.005). The sagittal correction angle (p = 0.034) and daily lengthening rate (0.80 vs. 0.70mm/day; p = 0.038) were slightly higher in the IEF group. Both AF and IEF are effective for pediatric deformity correction and lengthening. The IEF technique achieved greater sagittal correction and slightly faster lengthening. However, AF facilitates multiple adjustments, which can improve outcomes in complex tibial or sagittal-dominant deformities.

PURPOSE-Limb reconstruction system (LRS) fixators have been used in the management of complex tibial fractures with severe soft tissue injuries, compound tibial fractures, and infected tibial non-union for which conventional internal fixation cannot be contemplated. Fracture union and distraction osteogenesis can be done simultaneously with these external fixators , allowing early weight bearing. Thus, a prospective observational study was done to evaluate the union rate, functional outcome and limb length discrepancy in compound segmental tibial fractures managed primarily by LRS fixators. METHODOLOGY-A prospective observational study was conducted at Agartala Government Medical College &amp; GBP Hospital, Tripura, India and included two patients with compound segmental tibial fracture. The patients underwent LRS fixation and followed up at 1 month, 3 months, 6 months and 1 year. Functional and radiological outcomes were assessed using the Association for the Study and Application of Methods of Ilizarov (ASAMI) criteria. RESULTS-Union was achieved and radiological outcome was found excellent. Functional result was satisfactory. Post operative evaluation showed no pin-tract infection, loosening of pin, breakage of pin, assembly loosening, knee stiffness, ankle stiffness, neurovascular complication, limb length discrepancy, chronic osteomyelitis and delayed union. The patients achieved full range of motion at knee (0 to 135 degree), plantar flexion (0 to 45 degree) and dorsi flexion (0 to 20 degree). CONCLUSION-In this assessment, LRS fixators showed a favorable result in terms of fracture union and functional outcome with good healing of the soft tissues and maintenance of the limb length.

Introduction: Tibial non-union, particularly when associated with infection, remains a challenging problem in orthopaedic practice due to bone loss, soft tissue compromise, deformity, and limb length discrepancy. The Ilizarov circular external fixator offers stable fixation and allows correction of these associated problems through the principles of distraction osteogenesis. However, prospective data evaluating both bone and functional outcomes using standardized scoring systems are limited. Objective- To evaluate the clinical, radiological, and functional outcomes of Ilizarov ring fixation in patients with tibial non-union. Materials and Methods: This prospective observational study was conducted at a tertiary care teaching hospital from August 2017 to October 2018. Fifteen patients aged 11–70 years with diaphyseal tibial non-union, including infected and aseptic cases, were treated using the Ilizarov circular external fixator. Preoperative evaluation included clinical, laboratory, and radiological assessment. Corticotomy and bone transport were performed when indicated. Patients were followed up at regular intervals, and outcomes were assessed using the Association for the Study and Application of the Method of Ilizarov (ASAMI) scoring system. Results: Most patients were aged 21–40 years, with right-sided involvement being more common. Middle-third tibial non-union was the most frequent site. Corticotomy was performed in 60% of patients. The mean time to union was 6.03 ± 1.47 months (range 4–9 months). Complications included pin tract infection (26.67%), nonunion site infection (26.67%), ankle stiffness (40%), and knee stiffness (13.33%), all managed conservatively. Excellent to good bone and functional outcomes were achieved in 93.34% of patients according to ASAMI criteria. Conclusion: Ilizarov ring fixation is an effective method for managing tibial non-union, providing satisfactory union rates and functional outcomes while allowing correction of associated deformities and limb length discrepancy with acceptable complications.

Finite Element Analysis of Trans-Sutural Distraction Osteogenesis on the Nasomaxillary Complex in Adolescents with Cleft Lip and Palate.

Comparative assessment of 3D-printed patient-specific surgical guides for maxillary anterior segmental distraction osteogenesis (MASDO): Avoiding the risk of tooth damage

ObjectiveWe assess current practices in treatment of maxillary hypoplasia in patients with cleft lip and palate regarding LeFort I osteotomy (LFO) and maxillary distraction osteogenesis (DO).DesignA 27-question survey was distributed to surgeons in the United States via email addresses obtained through the American Cleft Palate Craniofacial Association (ACPA) website, the ACPA online forum, and a surgeons group on WhatsApp.SettingResponses were recorded in the REDCap platform.Patients and ParticipantsSurgeons treating these patients in the United States were included. Surgeons outside the United States, residents, students, and those not caring for these patients were excluded.InterventionsThere were no interventions due to the nature of this study.Main Outcome MeasuresQuestions assessed specialty and experience of respondents, treatment considerations guiding practices (risks of treatment, technique, timing, pre- and post-operative assessment).ResultsFifty-three surgeons responded to the survey. Sixty-six percent would consider DO for severe maxillomandibular discrepancy, 51% for LFO. Relapse (30%), inability to adequately mobilize (47%) are concerns for LFO; vector control (34%), compliance (18.9%) for DO. At ages 16 to 20 81.1% would consider both, whereas age ages 11 to 15 49.1% would consider DO. Lag phase of <7 days (98.1%), activation at 0.6 to 1 mm/day (71.7%), consolidation of at least 10 weeks (66%) are preferred.ConclusionsSurgeons prefer DO for large maxillomandibular discrepancy and scarring from previous surgeries, note less concern for maxillary relapse with DO, but have concern for controlling vector. Surgeons prefer lag phase of <7 days, activation at 0.6 to 1 mm/day, and consolidation of ≥10 weeks.

Introduction The use of combined techniques for long bone lengthening in patients with Ollier disease is of interest due to issues of both external fixation time reduction and improvement in the strength properties of the lengthened bone. The uniqueness of the presented clinical case is simultaneous femur and tibia lengthening over a titanium telescopic rod in the femur and tibia combined with external osteosynthesis and osteotomies. The purpose of this study is to demonstrate the stages and results of polysegmental bone lengthening in a child with Ollier disease using a technique combining the Ilizarov fixator and a titanium telescopic rod. Material and methods This clinical case is a five-year-old patient with Ollier disease without comorbidities, but with a significant discrepancy in the length of the lower limbs, impaired weight-bearing ability, and impaired gait biomechanics. Surgical treatment included multisegmental femur and tibia lengthening over a titanium telescopic rod inserted retrograde into the femur and antegrade into the tibia, simultaneous osteotomies and placement of a wire-and-halfpin external fixator. Results Exceptional data were obtained confirming the possibility of the titanium telescopic rod extension during distraction by more than 20 % without locking or loss of fixation of the threaded parts in the epiphyses. The elongation amounted to 11.4 cm (femur: 5.8 cm; tibia: 5.6 cm). The overall external fixation index was 12.02 days/cm. At a 12-month follow-up after dismantling the Ilizarov apparatus, growth of the elongated bones and telescoping of the femoral rod continued. Discussion This combined technique is consistent with the current concept of extended telescopic reinforcement in children with genetic diseases. The divergence of the titanium rod components both during the distraction period and during the first year after completion of limb lengthening demonstrates the feasibility of this combination and the reliability of using a telescopic titanium rod. This study demonstrates for the first time that rapid divergence does not predispose to locking of titanium rods and continues with growth. Conclusion This case demonstrates the effectiveness of using a combination of telescopic intramedullary titanium rods and external fixation for simultaneous lengthening of two adjacent segments in a child with Ollier disease. The findings on further natural growth of the lengthened segments along with telescoping of the rod are unique.

Temporomandibular joint (TMJ) ankylosis impairs jaw function, limiting mouth opening, speech, and mastication, and rendering airway access high-risk. In patients with syndromic conditions such as Pierre Robin Sequence (PRS) and Klippel-Feil Syndrome (KFS), ankylosis presents additional challenges due to airway compromise, restricted mandibular growth, and complex skeletal abnormalities. In addition, predicting the ability to advance the mandible using a prosthesis may be challenging due to anatomic factors. We report the case of an 18-year-old female with TMJ ankylosis, PRS, and KFS, presenting with severe trismus, retrognathia, and failed prior distraction osteogenesis. Imaging confirmed bilateral bony TMJ ankylosis and high-risk airway anatomy due to cervical spine fusion to the skull base. The patient underwent a staged surgical reconstruction involving ankylosis release and delayed alloplastic joint replacement with mandibular advancement. A later revision using new patient-fitted condylar components retained the fossa components and advanced the mandible an additional amount. The prosthetic outcome for mandibular advancement remains excellent six years after final reconstruction. There is no evidence of wound dehiscence, prosthesis loosening, or failure, and overall function remains significantly improved. This case highlights the complexities of TMJ ankylosis in a patient with multiple craniofacial syndromes and demonstrates the importance of individualized, multidisciplinary planning and the utility of prosthetic TMJ reconstruction. Revision using a new condylar component to further advance the mandible is a potential means of treatment while maintaining the fossa component to minimize variables at the time of surgery.

Robotic-assisted surgery is increasingly incorporated into facial plastic and reconstructive surgery (FPRS) procedures. However, the extent to which robotics improves operative performance or clinical outcomes in FPRS remains unclear. This systematic review and meta-analysis evaluates current applications of robotic-assisted FPRS. A PRISMA-guided systematic search of PubMed/MEDLINE, Embase, Cochrane, Web of Science, and Google Scholar (January 2020-November 2025) identified clinical studies investigating robotic-assisted FPRS procedures. Data extracted included robotic platform used, surgical indication, operative time, personnel involvement, complications, and outcomes. A random-effects meta-analysis was performed for operative time when sufficient data were available. Fourteen studies met the inclusion criteria. Seven robotic systems were used, most commonly the CARLO® device and the da Vinci Xi system (n = 3, 21%, respectively). Robotic systems were used for craniomaxillofacial (n = 8, 57%), oculoplastic (n = 3, 21%), reconstructive microsurgical (n = 2, 14%), and otolaryngologic procedures (n = 1, 7%). More personnel were needed for robotic cases, frequently involving two surgeons. Five studies were eligible for meta-analysis. Robotic procedures showed a pooled mean operative time of 150.8min versus 122.7min for manual surgery, with a mean difference of + 20.3min (95% CI -11.0 to 51.6). Procedure-specific differences varied widely: robotic distraction osteogenesis was faster, whereas robotic microvascular anastomosis, mandibular contouring, and maxillofacial reconstruction were slower. Complication rates were low overall. Robotic-assisted FPRS appears feasible by offering improved precision but generally requires longer operative times. As robotic systems evolve, and workflows become standardized, broader clinical integration should be expected.

To evaluate the application value of infrared thermography in breast reconstruction, cosmetic surgery, and limb reconstruction. A retrospective analysis of clinical data from 67 patients undergoing breast reconstruction and cosmetic procedures and 30 patients undergoing limb reconstruction between February 2022 and June 2025. The patients undergoing breast reconstruction and cosmetic surgery were all female, aged 25-60 years with a median age of 48 years. Procedures included breast reconstructions in 48 cases, breast reductions in 8, nipple reconstructions in 5, revision breast reconstructions in 2, revision nipple reconstruction in 1, and labia minora reductions in 3. Among the patients undergoing limb reconstruction, 18 were males and 12 were females, aged 29-62 years with a mean age of 43 years. Procedures included skin flap transplants for wound repair in 10 cases, fracture internal fixation in 17, and limb lengthening reconstructions in 3. An infrared thermography device was applied intraoperatively and within 48 hours postoperatively to monitor flap and distal limb temperature and vascular perfusion. Intra- and post-operative infrared thermography assessment indicated 2 positive cases (2.1%, 2/97), comprising 1 false positive. Among the 95 negative cases (97.9%, 95/97), 1 false negative was recorded. After operation, 1 case of immediate breast reconstruction exhibited localized vascular compromise at the edge of the local flap, though infrared detection showed no abnormally low skin temperature. The wound healed with delayed healing following dressing changes. One case of latissimus dorsi myocutaneous flap exhibited persistent infrared hypothermia during transfer. However, the flap demonstrated active dermal hemorrhage and a positive pinch test. Continuous monitoring revealed a subsequent rise in flap temperature, confirming adequate perfusion. The flap survived, with primary wound closure achieved. The postoperative infrared thermal imaging monitoring of the surgical site indicated adequate blood supply with no local ischemic necrosis in other patients. All patients were followed up. The patients undergoing breast reconstruction were followed up 1-30 months, with a median follow-up time of 15 months. The reconstructed breasts and nipples demonstrated good survival. The patients undergoing labia minora reduction were followed 3, 8, and 13 months, respectively. The surgical sites exhibited favorable appearance and blood supply. The patients undergoing limb reconstruction were followed 1-12 months (mean, 7 months). Transplanted flaps showed good survival, and patients with fractures or limb lengthening achieved favorable limb recovery. Infrared thermography offers a convenient, non-invasive, and objective supplementary indicator for breast and limb reconstruction. This technology can be used intra- and post-operatively to assess blood supply, thereby aiding surgical decision-making and reducing the risk of postoperative complications. However, attention should be paid to the potential for false positives and false negatives.

Callus distraction during leg lengthening procedures often leads to a reduction in muscle strength. This study explores whether this decline is temporary or if it persists long-term, with a follow-up period of 10 years. A cohort of nine patients underwent femoral lengthening with a motorized intramedullary device. We measured the maximum isokinetic concentric torque of the knee extensors and flexors preoperatively, at 2 years and at 10 years postsurgery. For this analysis, we included all patients with a full dataset and a minimum follow-up of 10 years (n = 9). We analyzed the differences between preoperative and postoperative maximal isokinetic torques and compared them with a control group of 10 healthy individuals. Before surgery, the median maximal isokinetic torque of the extensor group was higher in the unaffected leg compared to the shorter leg. After leg lengthening, the difference in extension torque between the unaffected and the lengthened legs increased at the 2-year follow-up and even more after 10 years. In contrast, no change was observed in the knee flexor group and there was no significant loss of maximal isokinetic torque in the lengthened leg. In the control group, the comparison between the dominant and nondominant leg showed a difference in knee extension torque of 2.9% and in knee flexion torque of 1.7% in favor of the dominant leg. Distraction of the muscle appears to have a higher long-term impact on the muscle properties than previously thought.

Mandibular distraction osteogenesis (MDO) is a critical intervention for addressing severe upper airway obstruction in infants with Robin Sequence (RS). Nonetheless, this procedure carries a risk of facial nerve dysfunction (FND), particularly affecting the marginal mandibular nerve (MMN). Since 2019, our group has prospectively monitored real-time facial nerve conduction using electroneurography (ENoG) during MDO procedures. This pilot study evaluates nerve conduction changes and their potential association with postoperative clinically visible FND. Nine infants with RS undergoing MDO from 2019-2024 were randomly selected from a prospectively enrolled cohort. ENoG recorded motor responses from the orbicularis oculi and mentalis muscles. Significant changes were defined as a peak latency increase of ≥10% or an amplitude decrease of ≥60% from baseline. Twenty-five unilateral procedures [osteotomy/placement of hardware (18); hardware removal (6); revision (1)] were analyzed by a certified ENoG technician. Median age at surgery was 11.4 months (IQR 2.4-42.7). Retraction during osteotomy was the surgical step most associated with a significant amplitude decrease in 83.3% of cases, while device activation caused the most frequent peak latency increase in 44.4% of cases. Temporary MMN dysfunction was observed after four procedures (16.0%). Sensitivity/specificity were 17.6%/87.5% while NPV was 84.8%. This prospective pilot study suggests intraoperative risk of MMN injury during MDO is greatest during retraction for osteotomy and device activation. With an NPV of 84.8%, ENoG predicted the absence of postoperative FND when there were no significant conduction changes. Further research is necessary to confirm its diagnostic utility and establish standardized pediatric intraoperative ENoG thresholds.

Correction of lateralization of the intermediate segment in biplanar distraction osteogenesis of the mandible using external elastics: A non-invasive innovative technique with a case presentation.

IntroductionTotal Hip Arthroplasty (THA) is a widely performed orthopaedic surgery, essential for treating severe pain and mobility issues arising from various conditions. The anticipated rise in Total Hip Arthroplasty (THA) procedures underscores the critical importance of their success, which is heavily dependent on the accurate positioning of prosthetic components. Various approaches like the Direct Anterior Approach with Fluoroscopy (DAA-F THA) and Robotic-assisted THA (RA THA) have their limitations. Computer-Navigated THA (CN THA) has emerged as a promising alternative, offering real-time feedback and potentially enhanced accuracy in component placement. This study evaluates the precision of CN THA in correcting leg length discrepancies and accurately positioning the acetabular component.MethodsThe study involved 122 consecutive patients undergoing direct anterior CN THA by the senior author. Exclusions were based on different surgical approaches, need for revision surgery, and infections. The study focused on the precise placement of acetabular components and leg length restoration. CN THA was used for intra-operative measurements, while post-operative radiographs were analyzed with TraumaCad® for comparison. Statistical analyses included Pearson correlation coefficients and descriptive analyses.ResultsCN THA showed high accuracy in leg length restoration with 85.25% of cases showing less than 5mm discrepancy. Similarly, acetabular component positioning was precise, with 90.98% of inclination and 74.59% of anteversion measurements within acceptable ranges. The correlation between intra-operative and post-operative measurements was strong, indicating the reliability of CN THA measurements.ConclusionCN THA was shown to be highly accurate in correcting leg length discrepancies and achieving proper acetabular component positioning. The strong correlation between intra- and post-operative measurements underscores the reliability of CN THA. The study, however, is limited by its single-surgeon, single-approach design, and lack of a control group. Despite these limitations, CN THA shows considerable potential in improving THA precision, enhancing surgical outcomes, and customizing patient care.

Does Lateral Pterygoid Muscle Reattach After Ramus-Condyle Unit Reconstruction in Temporomandibular Joint Ankylosis Patients?

Distraction Osteogenesis Maxillary Expansion (DOME) in Isolated and Personalized Multilevel Surgery for Obstructive Sleep Apnea: The First Clinical Case Series in Thailand

Surgical planning using three-dimensional (3D) technologies has become increasingly popular in complex procedures, notably in maxillofacial surgery. Most existing literature emphasizes preoperative planning and guide fabrication, with limited focus on intraoperative validation of these plans. This study presents a novel protocol incorporating intraoperative 3D planning and cone-beam computed tomography verification in paediatric mandibular distraction osteogenesis for hemifacial microsomia. The proposed workflow integrates preoperative 3D planning, 3D printing of surgical guides, and intraoperative CBCT assessment to evaluate distractor positioning and surgical accuracy in real time. A retrospective analysis of seven cases demonstrated that intraoperative planning enabled the detection of distractor deviations. The results show that the use of 3D technologies in the planning and execution of paediatric mandibular distraction procedures is a valuable tool that has the potential to improve the accuracy and efficiency of the surgical process. It allows for an intraoral approach, a personalized surgical planning, and real-time feedback during the procedure.

Background: Low-intensity pulsed ultrasound (LIPUS) is a non-invasive biophysical modality shown to enhance bone healing through mechanotransduction. Its role in maxillofacial bone regeneration remains less clearly defined compared with orthopaedic applications. Methods: This systematic review was conducted in accordance with PRISMA guidelines, synthesizing clinical and translational evidence on the use of LIPUS in maxillofacial bone healing. Electronic databases were searched for studies published between 2000 and 2025 evaluating mandibular fractures, distraction osteogenesis, orthognathic surgery, and dental implant osseointegration treated with LIPUS. Outcomes relevant to bone union, mineralization, pain reduction, and functional recovery were narratively analyzed, and risk of bias was assessed using appropriate standardized tools. Results: Included studies demonstrated accelerated radiographic union, increased early bone density, enhanced callus maturation, improved peri-implant bone preservation, and reduced postoperative pain with LIPUS therapy.Several studies also reported earlier functional recovery and improved clinical stability compared with conventional treatment protocols. However, heterogeneity in study design, outcome measures, and treatment parameters was noted, highlighting the need for standardized protocols and high-quality randomized controlled trials. Conclusion: LIPUS appears to be a safe and promising adjunct for maxillofacial bone healing, although further high-quality randomized trials are required to establish standardized protocols and definitive clinical guidelines