Maxillary Distraction Device Research Articles

Retrospective Comparative Study of Lefort I Osteotomies With External or Internal Maxillary Distraction Devices

Introduction: This investigation aims to evaluate outcomes of LeFort I distraction osteogenesis (DO) using external distraction (ED) versus internal distraction (ID), focusing on acute complication rates and relapse/malocclusion necessitating a secondary LeFort I osteotomy. Factors associated with a higher likelihood of complication and secondary surgery are also described. Methods: A retrospective review of 467 electronic medical records was conducted for patients who underwent at least one maxillary or mandibular orthognathic procedure between 2003 and 2023. Results: Among these patients, 17% (79/467) underwent LeFort I with maxillary distraction and had at least 30 days of follow-up for acute complications. Eleven percent (50/467) underwent LeFort I with maxillary distraction and had at least 2 years of follow-up for the likelihood of a secondary LeFort I procedure. A statistically significant difference was seen in the number of acute complications for patients who used ED versus ID devices after LeFort I osteotomy with distraction. The need for secondary LeFort I osteotomy was not significantly different between patients using ED and ID devices. Conclusion: The complication and reoperation rates reported here may help counsel patients and families about potential outcomes and expectations for LeFort I advancement using ED and ID devices, as well as provide a point of comparison for future investigations.

Correction of maxillary hypoplasia using modifi cation of Anterior maxillary distraction device in a patient with Binder’s Syndrome- Case report

This is the case report of a 20year old female, affected by Binders Syndrome reported to our hospital and was operated for maxillary hypoplasia using modifications of the standard Anterior Maxillary Distraction (AMD) device.

Correction of maxillary hypoplasia using modifi cation of Anterior maxillary distraction device in a patient with Binder’s Syndrome- Case report

This is the case report of a 20year old female, affected by Binders Syndrome reported to our hospital and was operated for maxillary hypoplasia using modifications of the standard Anterior Maxillary Distraction (AMD) device.

Traction vasculogenesis: Experimental vessel elongation by traction in rat model

Background: Microsurgeons may face inadequate vessel length in traumatic or post-resection vascular defects and flap surgery. As tissue regeneration by mechanical forces is possible like in tissue expansion and distraction osteogenesis, we questioned the effect of traction forces on isolated vessels, generated by an internal maxillary distraction device to overcome such problem. Methods: 30 Wistar-Albino rats were randomized in two groups as control and traction. By an internal maxillary distraction device placed subcutaneously to abdominal region, femoral artery and vein of traction group were applied daily traction for 10 days perpendicular to their course. Control group received the same procedure but no traction was applied. Vessel length, blood flow and histologic and microangiographic changes were evaluated on postoperative 11th day. Results: Final length of vessels was found to be higher in the traction group (21.93 mm) compared to control group (12.86 mm). (P = 0.000) Blood-flow patency rate of artery and vein was found 100 % in control group (n = 15) and 80 % in experiment group (n = 12). Microangiographic study showed patent blood flow in both control and traction groups. Histologic evaluation showed vascular wall thickening, perivascular adipocyte and neutrophil infiltration and vein lumen enlargement compared to control group. Conclusion: The preliminary “traction vasculogenesis” technique is found to be a promising technique to gain vessel length in vascular shortness problems. With further studies and refinements this technique may be carried to clinical applications in cases of vascular inadequacy.

Can Use of Rigid Fixation After Consolidation Increase Stability in Cleft Patients Following Distraction Osteogenesis?

The stability of distraction osteogenesis (DO) is an important issue in maxillary advancement for patients with cleft lip and palate (CLP). The aim of this study was to evaluate postoperative stability in patients with and without internal fixation after removing maxillary distraction devices. This randomized clinical trial assessed patients with CLP who needed maxillary advancement greater than 6mm; they were randomly assigned to 1 of 2 groups. In group 1, distraction devices were removed 3months after distraction and then 4L miniplates were placed bilaterally in the maxilla. In group 2 (controls), no miniplates were placed after removing the distraction devices. Lateral cephalograms taken on 3 occasions (preoperatively, immediately after removing the distraction device, and after 18months) were used to determine vertical and horizontal changes at the A point. Twenty-two patients (n=11 per group) were included. There was no significant difference between groups for horizontal relapse (P=.79). The results showed no significant difference for vertical relapse between the 2 groups (P=.11). The Pearson correlation test showed a correlation between the amount of advancement and horizontal relapse at the A point in group 1 (P=.01) and group 2 (P=.001). In group 1, for every 1-mm maxillary advancement, a 0.36-mm relapse was seen (B=0.36, P=.01). In group 2, for every 1-mm maxillary advancement, a 0.43-mm relapse was seen (B=0.43, P=.001). According to these results, rigid fixation after consolidation did not increase stability in patients with CLP after DO.

A Rare Complication Associated with Distraction Osteogenesis in Correction of Maxillary Hypoplasia

Aim: Distraction osteogenesis (DO) is an alternative to orthognathic surgery that appears to have some advantages for advancement in the maxilla and mandible, but relatively high complication rates have been reported in the maxillofacial region.
 Methodology: A 22-year-old female with the chief complaint of maxillary hypoplasia was referred to our clinic. A two-stage procedure combining maxillary advancement by distraction technique with mandibular setback surgery was performed to correct jaw deformity. At the sixth day of the distraction breakage of the device occurred. The distractors were removed and the patient was treated using conventional osteotomy techniques to achieve good occlusion and improve the facial profile
 Results: Besides there are a number of studies about complications of DO, breakage of distractor has been really rare reported. In our case this unexpected and a very rarely reported complication occurred.
 Conclusions: The purpose of the present case report is to present an undesirable and very rare complication associated with the maxillary distraction device and an alternative treatment method for managing this undesirable failure.
 How to cite this article: Apaydın A, Yenigün S, Can T. A Rare Complication Associated with Distraction Osteogenesis in Correction of Maxillary Hypoplasia. Int Dent Res 2012;2:23-26.
 Linguistic Revision: The English in this manuscript has been checked by at least two professional editors, both native speakers of English.

Skeletal and soft tissue changes and stability in cleft lip and palate patients after distraction osteogenesis using a new intraoral maxillary device

BackgroundThe authors have recently reported on the use of an internal maxillary distraction device. In this study, we report on the hard and soft tissue movements achieved with this intraoral distraction device, and the stability changes after distraction osteogenesis for maxillary hypoplasia in patients with cleft lip and palate. MethodsTen male patients with severe hypoplasia of the maxilla, with complete uni- or bilateral cleft lip and palate were included. The mean age of the patients at the time of operation was 11.91 years (±3.41). To evaluate the distraction process and stability, superimpositions on the preoperative lateral cephalograms were performed. The mean follow-up (FU) was 15.42 months (±3.94). ResultsCephalometric measurements at all of the maxillary hard and soft tissue points improved significantly. Maxillary point A was advanced by 8.25 mm (±3.17; P < 0.001). After distraction soft tissue point A′ had advanced 7.10 mm (±2.69; P < 0.001). The soft tissue to hard tissue ratio at point A was 0.86:1 after distraction. Maxillary horizontal relapse at point A was 14.1% at FU. Vertical relapse was not significant. ConclusionThis rigid intraoral distraction device can be successfully used in the correction of severe maxillary hypoplasia. The marked aesthetic improvement and low psychological encumbrance make this device viable for the treatment of cleft-related hypoplasia of the maxilla.

Diseño de un distractor interno para el avance maxilar en pacientes con labio y paladar hendido

IntroductionCleft lip and palate (CLP) is the most frequent craniofacial defect. (1:1000 newborns). CLP patients present severe maxillary retrusion that require a surgical procedure to advance their maxilla. Distraction osteogenesis is an effective treatment; however available internal maxillary distraction devices present inconveniences. ObjectiveTo design a biocompatible, inexpensive and mechanically efficient prototype of an internal maxillary distraction device. This device should be easy to place and comfortable for the patient. MethodComputed tomography (CT) data of an adult CLP patient was obtained. DICOM files were processed and a stereolitographic (STL) model was printed. Computer aided design (CAD) software was used to design the device and to perform a finite element analysis (FEA) to evaluate the mechanical behavior of the appliance. Finally a prototype was manufactured by a computer aided manufacturing (CAM) process and tested on the STL model. ResultsThis prototype complied with our requirements for an efficient internal maxillary distraction device. ConclusionsThe integration of clinical knowledge with novel technology (CT, STL, CAD, FEA, and CAM) is very useful for the development of medical or dental appliances.

Design of an internal distraction device for maxillary advancement in cleft-lip-palate patients

IntroductionCleft lip and palate (CLP) is the most frequent craniofacial defect. (1:1000 newborns). CLP patients present severe maxillary retrusion that require a surgical procedure to advance their maxilla. Distraction osteogenesis is an effective treatment; however available internal maxillary distraction devices present inconveniences. ObjectiveTo design a biocompatible, inexpensive and mechanically efficient prototype of an internal maxillary distraction device. This device should be easy to place and comfortable for the patient. MethodComputed tomography (CT) data of an adult CLP patient was obtained. DICOM files were processed and a stereolitographic (STL) model was printed. Computer aided design (CAD) software was used to design the device and to perform a finite element analysis (FEA) to evaluate the mechanical behavior of the appliance. Finally a prototype was manufactured by a computer aided manufacturing (CAM) process and tested on the STL model. ResultsThis prototype complied with our requirements for an efficient internal maxillary distraction device. ConclusionsThe integration of clinical knowledge with novel technology (CT, STL, CAD, FEA, and CAM) is very useful for the development of medical or dental appliances.

Five years experience with a new intraoral maxillary distraction device (RID)

Maxillary distraction osteogenesis is well established for the treatment of severe retromaxilla. We report our experience since 2004 of the treatment of 19 patients using a new intraoral maxillary distraction device. Maxillary advancement was successful in all patients with mean advancement of 9.6 mm (range 4–17) measured at a point in lateral cephalograms. The new device limited surgical exposure and the amount of materials implanted, and improved control in every phase of the distraction. It was psychologically accepted by patients and was more comfortable than existing devices.

Le Fort I distraction osteogenesis of the edentulous maxilla

Rehabilitation of the edentulous patient with atrophic ridges is a problem especially when compounded with a severe prognathic inter-arch relationship. It is difficult to rehabilitate these patients prosthetically without correction of the malrelation of the jaws. The established surgical techniques for correcting combined sagittal and vertical discrepancies of edentulous jaws are often prolonged and complex with attendant morbidity. This article presents a novel, simple method of correction of severe interarch sagittal discrepancy (more than 15 mm) by performing distraction osteogenesis at Le Fort I level using an internal maxillary distraction device. This method is a simple, predictable and stable option for the correction of a severe, unfavourable intermaxillary relation in edentulous patients.

Maxillary Distraction Osteogenesis for Advancement in Cleft Patients, Internal Devices

Choosing a maxillary distraction device or any distraction device is based upon the surgical goals intended for the individual patient. Choosing a device for the cleft lip and palate patient with skeletal maxillary deficiency is no exception. The basic goals of any maxillary advancement surgery are to create a stable functional occlusion and good facial esthetic form.

Use of indigenous internal maxillary distraction device for hypoplastic maxilla—an Indian experience

Purpose: Distraction osteogenesis is an established method to correct sagittal discrepancies of the maxilla in severe cases of maxillary hypoplasia. The purpose of this paper is to review the experience and results with the use of an indigenously made internal, submerged, maxillary distraction device for the treatment of severe maxillary hypoplasia. Patients and materials: Eighteen patients have undergone maxillary distraction with an indigenously made distraction device in a period of over two and a half years. Follow up ranged from 6 months to 3 years. All patients had serial orthopantamograms and lateral cephalograms. Seven patients had a 3-D CT scan to evaluate soft tissue changes. Latency period prior to distraction was 5 days. Advancement was done at the rate of 1 mm per day. The device was removed after 3 months upon radiographic confirmation of consolidation. Results: All 18 patients underwent successful distraction as planned. The minimal advancement was of 8 mm up to a maximum of 25 mm. In six patients, an anti clockwise rotation of maxilla was observed with a tendency to anterior open bite. Callous manipulation was successfully carried out and all patients had good occlusal results following inter maxillary fixation. Minor complications included mild infection well controlled by local methods.

Protection of the lip from the activator arm of maxillary distractors

<h2>Summary</h2> The long spring-loaded distractor arms of maxillary distraction devices can cause pain and ulceration of the upper lip. We describe a simple method to relieve the tension and discomfort on the soft tissues using Silastic^® tubing.

Protection of the lip from the activator arm of maxillary distractors

The long spring-loaded distractor arms of maxillary distraction devices can cause pain and ulceration of the upper lip. We describe a simple method to relieve the tension and discomfort on the soft tissues using Silastic tubing.

Difficult tracheal intubation induced by maxillary distraction devices in craniosynostosis syndromes.

Difficult intubation occurred during anaesthesia for removal of maxillary distraction devices in five of seven children with syndromal craniosynostoses (four with Apert, two with Pfeiffer and one with Crouzon syndrome). Intubation was assessed in terms of laryngeal view and an established intubation difficulty score and had been straightforward before device insertion. Difficulty was induced by trismus due to device insertion and by increased maxillary prominence. This was compounded by preexisting mandibular hypoplasia. Cephalometric analysis, with each child acting as their own control, demonstrated anterior displacement of the maxilla and increased maxillary vertical height, as well as increased protuberance of the maxillary incisors. All five difficult tracheal intubations were associated with preoperative Mallampati scores of 3 or 4 and the nine straightforward intubations with scores of 1 or 2. Maximal interincisor distance was less than the lower 95% confidence limit for age in all five children who were difficult to intubate at the time of device removal. No child had a failed intubation, but all had significantly increased intubation difficulty. In view of the risks of trauma, hypoxia and aspiration associated with difficult direct laryngoscopy, we recommend elective fibreoptic intubation at anaesthesia for removal of maxillary distraction osteogenesis devices in these children.

Anterior maxillary advancement using tooth-supported distraction osteogenesis

Purpose: This study used the principle of distraction osteogenesis to advance the anterior maxilla of the dog using a totally tooth-supported distraction device. Materials and Methods: After an anterior maxillary osteotomy, the distraction device was activated 0.5 mm every 12 hours to advance the anterior segment 10 mm in 10 days. Results: Serial tooth and radiographic measurements indicated that on the 10th day the average tooth advancement was 8.4 mm ± 1.5 mm and the average skeletal advancement was 4.0 mm ± 1.5 mm. After 6 weeks the average tooth advancement was 7.2 ± 1.6 mm and the average skeletal advancement was 3 ± 1.3 mm. At 3 months the tooth advancement was 6.2 ± 1.5 mm and at 6 months the tooth advancement was 5.0 ± 1.1 mm. Bone healing was present in all animals. Conclusion: This results of this study indicate that a tooth-borne maxillary distraction device will result in significantly greater dental movement than skeletal movement and that skeletal fixation may be needed for appliances used to advance the maxilla.