Distraction Osteogenesis Research Articles

Endoscopic-assisted versus open fronto-orbital distraction for unicoronal craniosynostosis: morphometric and technique considerations

IntroductionIn an effort to maximize benefit and minimize morbidity when performing fronto-orbital distraction osteogenesis (FODO) for unilateral coronal synostosis (UCS), we have transitioned to an endoscopic-assisted approach (“endo-FODO”). This study compares photogrammetric outcomes of patients who underwent FODO via an endoscopic-assisted versus open approach.MethodsWe retrospectively reviewed patients treated for UCS from 2013 to 2023. Photogrammetric outcomes at one to three years postoperatively were compared between patients who underwent endo-FODO and age- and sex-matched controls who underwent open FODO. Differences between pre- and postoperative periorbital symmetry ratios, canthal tilt symmetry, and orbital dystopia angle (ODA) were calculated.ResultsTwenty patients (ten per group) underwent surgery at a mean age of 6.1 ± 1.8 and 5.4 ± 1.1 months (p = 0.426) and were photographed at 1.6 ± 0.9 and 1.8 ± 0.9 years (p = 0.597) postoperatively in the endo-FODO and open FODO groups, respectively. Patients who underwent endo-FODO demonstrated significant improvements in margin-reflex distance 1 (MRD1) symmetry ratio (p = 0.004), palpebral height symmetry ratio (p = 0.004), canthal tilt symmetry (p = 0.020), and ODA (p = 0.009). Patients who underwent open FODO likewise demonstrated significant improvements in MRD1 symmetry ratio (p = 0.004), palpebral height symmetry ratio (p = 0.033), and ODA (p = 0.004). All postoperative measurements as well as degrees of improvement were similar between groups (p > 0.05).ConclusionsEndo- and open FODO were associated with significant and comparable improvements in soft tissue periorbital symmetry and orbital dystopia at nearly two years postoperatively. While continued follow-up until cranial maturity is needed to assess the durability of aesthetic results, these data support a minimally invasive, endoscopic alternative to fronto-orbital distraction.

Factors Influencing Fronto-Orbital Relapse in Patients With Syndromic Craniosynostosis: A 2 Decade Review.

Fronto-orbital retrusion may occur after primary surgical correction of craniosynostosis, particularly in patients with syndromic craniosynostosis. This study investigated reoperation rates and factors contributing to FO relapse among this cohort. A retrospective review evaluated reoperation for FO relapse in patients with syndromic multisuture craniosynostosis who underwent primary fronto-orbital advancement (FOA) + calvarial vault remodeling (CVR) at our institution between 2004 and 2024. Revision surgeries included repeat FOA or monobloc advancement/distraction. FOA advancement distance was measured using postoperative computed tomography and Mimics software. ROC analysis evaluated the accuracy of FOA distance in predicting subsequent FO relapse. Conditional margins identified optimal advancement distances. Logistic regression of predictors of FO relapse adjusted for age at surgery, craniofacial syndrome, posterior vault distraction osteogenesis (PVDO), advancement distance, and postoperative helmet therapy. Fifty-two patients underwent a mean of 2.8±1.9 skeletal craniofacial procedures each. With a mean follow-up time of 9.2±6.5 years, 16 (30.8%) patients required reoperation for FO relapse. Larger advancement distances were the sole significant predictor of relapse, increasing the odds by 49.6% (OR 1.496, 95% CI: 1.085-2.063; P=0.014). Relapse rates were lower with advancements ≤17.2mm (0.0%) than with further advancements (42.0%, P=0.002). Specifically, advancements >18.8mm were associated with significantly higher relapse rates (P<0.05). Almost one-third of patients with multisuture syndromic craniosynostosis underwent FO region readvancement. Advancements <17.2mm during initial FOA appeared to mitigate relapse, while advancing beyond 18.8mm may increase the risk. Investigation of additional protective factors against FO relapse is encouraged to minimize surgical burden.

Radial cortex transverse distraction help to treat the Raynaud’s phenomenon

Raynaud’s phenomenon is a condition that causing vasospasm of the digital extremities and have a great influence on the quality of patients life. Distraction osteogenesis is accompanied with vascularization and regeneration of surrounding soft tissues. There have been no previous reports of using radial cortex transverse distraction for the treatment of RP. Since January 2019 to January 2023, 6 patients with RP accepted radial cortex transverse distraction. They were failed to conventional treatment for at least six months before the surgery. All the patients were followed-up over 1 year. The bone cortex healed without osteomyelitis or fractures. The ulcer of finger healed in one month. The pain and skin pale released after the surgery. The VAS score declined from 6 to 2 and the finger SpO2 improved. Radial cortex transverse distraction facilitated finger ulcer healing, salvage the hand and improved Raynaud symptoms. These findings suggest that radial cortex transverse distraction may be an effective procedure to treat the Raynaud’s phenomenon.Level of Evidence II Therapeutic study.

Hypertrophic nonunion management with distraction osteogenesis: a scoping review of the literature

Abstract Introduction: Traditionally, stiff hypertrophic nonunions have been managed with open preparation of the nonunion site, which is then secured with internal fixation. Alternative surgical options are available including distraction osteogenesis with an external fixator. There is currently a limited amount of literature pertaining to the use of distraction osteogenesis in the management of hypertrophic nonunion. The aim of this systematic review was to collate and assess the effectiveness of distraction osteogenesis (DO) in the management of hypertrophic nonunions and to evaluate the complications that are commonly reported in the literature. Methods: We searched for articles pertaining to the treatment of hypertrophic nonunion using distraction osteogenesis. Several electronic bibliographic databases and clinical trial registries were searched using the MeSH terms “hypertrophic non-union,” “distraction osteogenesis,” “stiff non-union,” and “External Fixation” in various combinations to return the maximal number of studies for review. We performed a systematic review and identified a total of 11 studies eligible for review. Results: The review of the literature demonstrated that this technique is highly effective in achieving bony union with minimal complications. The most common complication is mild superficial pin site infections, usually managed with oral antibiotics and effective wound hygiene. Other complications reported were deep pin tract infections, broken hardware, and deformity recurrence due to collapse of regenerate bone. Conclusion: The use of distraction osteogenesis with external fixator devices is an effective and safe method for producing bony union in hypertrophic nonunions. There were minimal associated complications.

SADI-S, state of the art. Indications and results in 2024: a systematic review of literature.

Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S) was proposed as a simplification of the biliopancreatic diversion (BPD) procedure with duodenal switch (DS) in order to reduce operative time and postoperative complications rate, however, keeping effectiveness in weight loss and in comorbidities' resolution. We performed a systematic review of the literature with the aim of summarizing the current evidence of SADI-S clinical outcomes in order to assess its effectiveness and safety, and a total of 17 studies were included. Short- and mid-term follow-up results were reported, with a mean TWL loss ≥ 25% at 12months and > 44% after 24months, comparable to BPD-DS, also in reoperative surgery. Comorbidity remission rates for T2D, hypertension, dyslipidemia and OSAS were of 75.8%, 61.2%, 60.4%, 71.9%, respectively. Some nutritional deficiencies were reported (total proteins, albumin, folate, Vitamin B12 and Vitamin D), but the hypoabsorption rate decreased with the lengthening of the common limb to 250/300cm. SADI-S can be defined as an efficient bariatric operation both as primary and reoperative procedure for recurrent weight gain, with good results in comorbidity resolution.

CAD/CAM surgical guides and pre-bent distractors: Enhancing precision in MDO for severe dentofacial deformities secondary to TMJ ankylosis.

This study aimed to compare the different outcomes of mandibular distraction osteogenesis (MDO) using computer-aided design and manufacturing (CAD/CAM) surgical guides accompanied by pre-bent distractors versus CAD/CAM surgical guides with commercial distractors. Twenty-eight patients with severe dentofacial deformities secondary to unilateral temporomandibular joint ankylosis (TMJA) were retrospectively enrolled. Ten parameters associated with MDO were measured preoperatively, virtually, and postoperatively. The hard-tissue digital model was reconstructed using Mimics Research 17.0, and imaging data were collected and analyzed using Freeform Plus software 12.0, Geomagic Studio 12.0, and IBM SPSS Version 20.0. Twenty-eight patients underwent MDO with subsequent adjunctive surgery and were evaluated. Thirteen patients underwent CAD/CAM surgical guides with pre-bent distractors (group A), while fifteen underwent CAD/CAM guides with commercial distractors (group B). Both techniques achieved optimal occlusion and satisfactory appearance. Statistical analysis showed group A demonstrated a more accurate control of vector direction during MDO compared to group B (p<0.05). Additionally, group A also exhibited a shorter subsequent treatment duration and less relapse compared to group B (p<0.05). CAD/CAM surgical guides with pre-bent distractors can significantly enhance surgical accuracy in controlling the vector direction of MDO for correcting dentofacial deformities secondary to TMJA, leading to a reduction in subsequent treatment duration and occurrence.

Social Perceptions of Preoperative and Postoperative Photographs of Patients With Syndromic Craniosynostosis Undergoing Le Fort III Advancement

In patients with syndromic craniosynostosis and midface hypoplasia, the Le Fort III osteotomy is a surgical intervention that alleviates nasopharyngeal obstruction and improves facial features that influence societal perceptions of a patient’s attractiveness and interpersonal characteristics. This study determines how perceptions of personality traits, expressed emotion, interpersonal experiences, and expected life achievements and experiences changed in pediatric patients with syndromic craniosynostosis and midface hypoplasia undergoing Le Fort III osteotomy with distraction osteogenesis. The goal of this study is to help quantify the significance of surgical interventions on these perceived social parameters to guide preoperative education and manage expectations with patients and their families.

Assembly of Custom Implant and Ready-Made Distractor for Precise Maxillary Movement Vector Control in Cleft Patient With Midfacial Hypoplasia.

This study presents a novel approach for maxillary advancement in a patient with cleft lip and palate, utilizing the assembly of a custom titanium implant and a ready-made distractor. The patient exhibited significant maxillary hypoplasia and had concerns regarding the possible deterioration of hypernasality after conventional surgical methods. Distraction osteogenesis was initiated to address these challenges. A custom plate was designed using 3-dimensional printing technology. Integrating the plates with off-the-shelf distractors enables precise control of the distraction vector to optimize surgical precision and outcomes. The treatment plan involved Le Fort I osteotomy, followed by a distraction protocol that achieved a skeletal Class I relationship and total advancement of 7.5mm and elongation of 2mm, with no reported complications. This case demonstrates that combining custom implants with standard distractors can provide precise maxillary repositioning at reasonable costs, while mitigating the risks associated with traditional surgical interventions and reducing the need for secondary corrective surgeries.

Cranial Base Changes After Trans-sutural Distraction Osteogenesis in Growing Patients With Cleft Lip/Palate and Midface Hypoplasia

Background: Transesutural distraction osteogenesis (TSDO) is a method of correcting midfacial hypoplasia (MH) secondary to cleft lip and palate (CLP) without osteotomy. However, there has been little research on how the morphology of the cranial base changes postoperatively or whether any correction of the cranial base occurs. Materials and Methods: This retrospective study included 35 pediatric patients with MH secondary to CLP, who underwent TSDO treatment. Pre-treatment and post-treatment cranial computed tomography (CT) images were collected for cranial base measurements using 3-dimensional (3D) modeling reconstruction. For the comparative analysis, 102 children with normal craniofacial CT images were selected after matching for age and sex. Results: Comparison with normal children of the same age showed that the lengths and angles of several cranial base segments approached normal levels after treatment. In total, the authors found extreme extension in the anterior segment of the sphenoid bone, and in the middle cranial fossa. Simultaneously, TSDO therapy led to the anteroposterior diameter of the lateral pterygoid processes and vomer bone greatly exceeding the normal range, thus causing forward development of the midface skeleton. Conclusion: After the TSDO procedure, the cranial base length and angles approached normal dimensions, accompanied by the forward advancement of the midfacial skeleton. Among the cranial base structures, TSDO resulted in the most noticeable increase in the sphenoid bone in terms of linear measurements and angles, thus promoting midfacial development in children.

Reactivating Sleeping Intramedullary Nail in a 16-Year-Old Female with Polyostotic Fibrous Dysplasia: A Case Report on Complications and Potential Solutions

Background: Fibrous dysplasia (FD) is a rare condition in which normal spongy and cortical bone is replaced by non-neoplastic fibrous tissue, leading to weakened bone matrix and increased risk of pathological fractures and deformities. Treating these deformities poses a significant challenge for surgeons. While various cases of surgical stabilization and limb lengthening using intramedullary nails have been reported, there is limited evidence on the use of Motorized Intramedullary Limb-Lengthening Nails (MILLNs) in FD patients. This case report presents the clinical history of a patient with FD who underwent multiple surgical interventions to address severe lower limb length discrepancy (LLD) and angular deformity caused by multiple fractures. Case presentation: A sixteen-year-old Caucasian girl with polyostotic FD developed a severe post-traumatic LLD of 10 cm on the right side, associated with coxa vara, valgus knee, and patellar instability. The deformity of the proximal femur was addressed with a valgus and derotational femoral osteotomy. However, this procedure exacerbated the knee’s valgus deformity and only partially corrected the LLD, leading to the decision to proceed with femoral lengthening. A retrograde magnetic intramedullary nail (PRECICE, NuVasive) was utilized for this purpose. Approximately three months postoperatively, radiographs revealed the loosening of the proximal anchoring screw, while the nail had reached maximum distraction. We then proposed reactivating the previously implanted nail. Nine months after the final surgery, standing long-leg radiographs showed a residual shortening of 1 cm, with excellent healing at the fracture sites and the nail and screws remaining securely in place. The patient was monitored regularly, with the latest follow-up occurring four years and five months after the conclusion of the last lengthening procedure. Conclusions: This case report describes the reactivation of a MILLN in a patient with polyostotic fibrous dysplasia. While nail reactivation has been previously described in the literature, to our knowledge, it has not been reported for treating complications arising from FD. In cases of mechanical complications, this approach can equalize leg length discrepancies and correct deformities, avoiding additional invasive surgeries and reducing healthcare costs. As this is an off-label treatment, preoperative consent from both the patient and the parents is required.

Success of Bone Ossification After Posterior Vault Distraction Osteogenesis in Patients With Craniosynostosis

Background: Posterior vault distraction osteogenesis (PVDO) is an effective treatment for multisuture and syndromic craniosynostosis. It remains unclear how well the calvarium ossifies after PVDO, especially in older patients when they have plateaued in their cranial growth phase. The purpose of this study is to report outcomes associated with PVDO across a wide range of ages at our institution. Methods: Operative details, distraction parameters, complications, and details of cranioplasty, if applicable, were obtained for all patients who underwent PVDO between March 2016 and July 2022. The surface areas of distraction sites and residual cranial defects were measured from computed tomography scans after a consolidation phase, and the percentages of the distraction regions with ossification were subsequently calculated. Results: Fifteen patients underwent PVDO at a mean age of 5.1 years (0.5–18.7 y). The mean percentage of ossification among all patients was 80.4% (59.1%–95.3%). The degree of ossification was not significantly associated with age at the time of surgery at the univariate level (Pearson-r=−0.15, P=0.573). Three patients (20.0%) required titanium mesh cranioplasty for definitive reconstruction, which was significantly more likely in patients who were &gt;4 years old at the time of PVDO (P=0.04). Conclusions: Complete ossification of the distracted area of the cranium is unlikely after PVDO. Ossification appears less robust with increasing age, although not statistically significant in our study population, likely due to the limited sample size. Future studies should assess the role of age, latency period, and distraction rate in minimizing residual defects.

Outcome of Titanium Elastic Nails in Pediatric Femoral Fractures

Background: Femoral fractures are common fractures in paediatric age group. There are various methods to treat such cases. Titanium elastic nailing is one of them and an established and reliable method for treating these types of fractures. Ideal treatment of fractures in the age group of 5 to 14 years is still a matter of debate as no consensus has been achieved till now. Aim of the study: The aim of this study was to evaluate the outcome of using titanium elastic nails (TEN) in pediatric femoral fractures. Methods: This observational prospective study was conducted in in the Orthopedic Department of Shaheed M. Monsur Ali Medical College, Sirajganj, Bangladesh during the period from January 2017 to December 2018. A group of 50 children with femoral fractures selected to treat with titanium elastic nailing were finalized as the study population. All the information along with the outcomes of the participants were collected assessed and disseminated by several tables and charts of MS Office program. Result: In 20%, 14%, 4% and 2% cases we found superficial infection, mal-union, deep infection and nail breakage as complication respectively. As the final outcome of this study we found, the results were excellent in 34 patients (68%) successful in 12 (24%) and poor in 4(four) patients (8%) as per the scoring criteria for TEN by Flynn et al. Entry site irritation occurred in 3 patients limb lengthening (&lt;1.5cm) was found in 3 cases both clinically and radiologically, which was clinically insignificant nail removal at 5th month, due to wound breakdown at entry sets in one case. Results were better for children in less than 10 years of age. Conclusion: Titanium elastic nailing is the method of choice for the simple pediatrics femoral fractures, as it was minimally invasive and showed good functional and cosmetic results. Surgical technique of this procedure is simple and reproducible. It always allows short hospital stay and quick recovery from pain and it is cast-free.

Evaluating Surgical Approaches for Hemimandibular Hyperplasia Associated with Osteochondroma: A Systematic Literature Review.

Background/Objectives: Hemimandibular hyperplasia (HH) associated with osteochondroma presents complex challenges in maxillofacial surgery, including facial asymmetry, occlusal instability, and temporomandibular joint (TMJ) dysfunction. Surgical interventions vary widely in approach and outcomes, underscoring the need for a systematic evaluation of effectiveness. This systematic review assesses the effectiveness of surgical approaches for managing HH associated with osteochondroma, focusing on techniques including condylectomy, orthognathic surgery, distraction osteogenesis, total joint replacement (TJR), and genioplasty. Methods: Following PRISMA 2020 guidelines, a comprehensive search was conducted in PubMed, Scopus, and Web of Science for studies published from 2000 to 2023. Eligibility criteria were based on the PICO framework, with primary outcomes evaluated for facial symmetry, occlusal correction, mandibular function, and recurrence rates. The Cochrane Risk of Bias Tool assessed study quality, while the GRADE framework evaluated the certainty of evidence. This review was not registered due to exclusion criteria for certain dental topics in PROSPERO. Results: Of 145 studies identified, 18 met inclusion criteria, totaling 214 patients. High and low condylectomy both effectively corrected asymmetry, with high condylectomy reducing recurrence risk but often requiring reconstruction. Orthognathic surgery, combined with condylectomy, significantly enhanced facial symmetry and occlusal function. Distraction osteogenesis proved valuable for mandibular lengthening in cases of severe deformities, while TJR offered definitive solutions for extensive joint involvement. Genioplasty corrected chin asymmetry, contributing to improved facial balance. Limitations included small sample sizes and variable follow-up durations. Conclusions: Surgical approaches tailored to individual patient needs show effectiveness in treating HH associated with osteochondroma, achieving functional and esthetic outcomes. Future studies should prioritize larger cohorts and standardized follow-up protocols to better assess long-term efficacy. Advances in 3D surgical planning and individualized treatment strategies show promise for optimized patient-specific care.

Efficacy of Invasive and Non-Invasive Methods in Orthodontic Tooth Movement Acceleration: A Systematic Review

Objective: The aim of this review was to evaluate the currently available scientific evidence on the efficacy of different methods as accelerators of tooth movement during orthodontic treatment: corticotomies, piezocision, micro-osteoperforations (MOP), photobiomodulation (LLLT and LED laser) and microvibrations. Search Methods: A comprehensive search was performed in the PubMed, Google Scholar, Scopus and Medline databases in May 2024. Selection Criteria: We selected randomized controlled trials based on acceleration of tooth movement during orthodontic treatment. Articles that were not randomized controlled trials (RCTs), were not published in the last ten years or corresponded to animal trials as well as those dealing with orthognathic surgery, distraction osteogenesis, electric currents, pulsed electric fields and pharmacological approaches were excluded. Results: Twenty-three studies were included in this review. All trials show accelerated tooth movement after low-level laser application, and seven studies support the efficacy of surgically assisted orthodontic treatment with corticotomies, piezocision or MOP. No article indicates statistically significant differences between the application of microvibration during orthodontic treatment and conventional treatment. No negative effects on the periodontium, loss of dental vitality or serious root resorption were reported in any publication, except in a study carried out with MOP (with an increase in root resorption). Conclusions: There is some evidence that low-level laser therapy and surgical methods are effective techniques in accelerating tooth movement during orthodontic treatment, while the evidence is very weak for vibration.

Comparative effectiveness of pre-epiglottic baton plates and mandibular distraction in infants with Robin sequence.

Mandibular distraction osteogenesis (MDO) and pre-epiglottic baton plates (PEBP) are both effective for early management of upper airway obstruction (UAO) in infants with Robin sequence (RS), but have not been directly compared. The purpose of this study was to compare early airway, feeding and growth outcomes between these treatments. This is a bicentric retrospective cohort study from 2015-2021 including infants with RS treated with MDO or PEBP before 6 months-of-age with pre- and post-treatment sleep studies and follow-up at least through age 1-year. The primary outcome was immediate post-intervention UAO, measured as obstructive apnea-hypopnea index (oAHI) or obstructive apnea index (oAI), as available. Latest follow-up sleep studies, feeding and growth characteristics were also assessed. 114 subjects were included: MDO, n=31 and PEBP, n=83. Pre-treatment UAO was similar between groups (p=0.61). PEBP was initiated at a younger age (median [IQR] 31 [14,53] vs. 41 [28,84] days-of-life, p<0.05). Significant reduction of oAHI/oAI was achieved in both groups, but greater with MDO (98%) compared to PEBP (94%, p<0.05). PEBP demonstrated better early feeding and growth outcomes compared to MDO, with fewer surgical feeding tubes (p<0.001) and more rapid early growth (p=0.038). When stratified by pre-intervention UAO, infants starting with moderate UAO experienced similar airway outcomes with both treatments (p=0.11), while those with severe UAO had greater resolution with MDO (p<0.001). Both treatments effectively relieve moderate UAO in infants with RS, but MDO is more effective for infants with severe respiratory compromise.

Efficacy of the maxillary anterior segmental distraction osteogenesis in patients with cleft lip and palate.

Cleft lip and palate (CLP) is one of the most common birth defects worldwide. It typically results in significant maxillary dysplasia, causing severe oral function problems and substantially affecting the patient's facial aesthetics. Maxillary anterior segmental distraction osteogenesis (MASDO) has gained popularity in recent years as an effective treatment for correcting maxillary dysplasia. However, the evaluation of its effectiveness in patients with CLP varies across different studies. Our research was aimed at providing evidence of the effects of MASDO among CLP patients. A meta-analysis covered Medline, Web of Science, Embase, Scopus, and Cochrane Library. Controlled clinical trial studies published before February 2024 and analyzed changes in maxillary cephalometric landmarks before and after MASDO among patients with maxillary hypoplasia and CLP were included. Our meta-analysis included 10 papers in total. One study was at low risk of bias, seven were at medium risk, and two were at serious risk. MASDO significantly increased the maxillary length. The mean SNA angle increased by 6.43° (95% CI, 4.11° to 8.74°) and A-McNamara rose by 7.29mm (95% CI, 6.21mm to 8.37mm). The maxilla also showed a slight counterclockwise rotation; however, this reached no statistical significance. The mandibular position did not vary remarkably. Moreover, a significant increase in upper anterior tooth tipping and overjet, a decrease in overbite, and an improvement in nasolabial soft tissue were observed. MASDO might be a valid therapy option for CLP patients. It causes a significant increase in the maxillary length, anterior tooth crossbite, and nasolabial soft tissue were also greatly improved.

Speech Assessments in Hypoplastic Cleft Maxilla Treated by Anterior Segmental Distraction Osteogenesis

Introduction: Cleft lip and palate (CLP) affect the craniofacial region, with significant implications for speech, hearing, feeding, and facial aesthetics. This study aimed to evaluate the impact of anterior maxillary segmental distraction osteogenesis (AMSDO) using an internal distractor on speech outcomes in CLP patients, assessed using the Pittsburgh Weighted Speech Scale (PWSS).Methodology: A single-center prospective study was conducted between March 2022 and April 2024. Twelve CLP patients with maxillary hypoplasia, aged 17.8 to 32.6 years, were included. Purposive sampling was done to include patients with complete unilateral or bilateral CLP who exhibited Class III skeletal relationships with reverse overjet greater than 7 mm. Speech assessments were conducted preoperatively (1-3 months before surgery) and postoperatively (5-7 months after distraction). Speech samples were recorded and evaluated by a licensed speech-language pathologist using the PWSS. Statistical analysis was performed using paired t-tests and Chi-square tests.Results: Significant improvements were observed in the total PWSS score (p = 0.03), nasality (p &lt; 0.001), phonation (p &lt; 0.001), and articulation errors (p = 0.004) postoperatively. No significant changes were seen in nasal emission and facial grimace. No correlation was found between the amount of distraction and speech outcomes. Unilateral cleft patients showed better outcomes than bilateral cleft patients, though not statistically significant.Conclusion: AMSDO significantly improves speech outcomes in CLP patients with maxillary hypoplasia. The PWSS is a reliable tool for assessing these changes. Further research with larger samples and longer follow-ups is warranted to confirm these findings.

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.

Rigid intramedullary nailing of lower limb segments in children and adolescents with metabolic bone disease.

Children and adolescents with metabolic bone disease present to the orthopedic surgeon with pain, fractures (which may be impending), and deformity. Different modalities of orthopedic management are available. Scant literature exists on the use of rigid intramedullary nailing in this population. This study sought to evaluate the utilization of this treatment modality in the pediatric cohort, focusing on indications, techniques, and outcomes of the procedures. A retrospective review was performed over an 11-year period at a single tertiary pediatric institution in the UK. Medical records and radiographs were reviewed. Preoperative surgical and medical management, time to bony union, and complications were specifically ascertained. Twenty-seven patients (63 lower limb segments) had rigid intramedullary nailing over the specified period. The majority of patients had an underlying diagnosis of osteogenesis imperfecta or fibrous dysplasia (including McCune Albright Syndrome). Surgical indications included acute fractures, prophylactic stabilization, previous nonunion and malunions, deformity correction, and limb lengthening. All fractures healed and deformity correction was successful. In one patient, delayed union occurred after deformity correction and was successfully treated with dynamization. Fractures healed faster than corrective osteotomies. Complications included implant prominence, cortical penetrance, and screw loosening. Nonunion occurred with limb lengthening in one patient. Rigid intramedullary nailing is a safe and effective method of treatment for lower limb fractures and deformities in children and adolescents. This technique is, therefore, recommended for patients with metabolic bone disease. However, care must be taken in preoperative surgical planning and a multidisciplinary approach should be utilized.

A 4D time-lapse morphometry method to quantify bone formation and resorption during distraction osteogenesis.

Distraction osteogenesis (DO) is widely utilized for treating limb length discrepancy, nonunion, bone deformities and defects. This study sought to develop a 4D time-lapse morphometry method to quantify bone formation and resorption in mouse femur during DO based on image registration of longitudinal in vivo micro-CT scans. Female C57BL/6 mice (n = 7) underwent osteotomy, followed by 5 days of latency, 10 days of distraction and 35 days of consolidation. The mice were scanned with micro-CT at Days 5, 15, 25, 35, 45, and 50. Histological sectioning and Movat Pentachrome straining were performed at Day 50. After registration of two consecutive micro-CT images of the same bone (day x and day y), the spatially- and temporally-linked sequences of formation, resorption and quiescent bones at the distraction gap were identified and bone formation and resorption rates (BFRdayx-y and BRRdayx-y) were calculated. The overall percentage error of the registration method was 2.98% ± 0.89% and there was a strong correlation between histologically-measured bone area fraction and micro-CT-determined bone volume fraction at Day 50 (r = 0.89, p < 0.05). The 4D time-lapse morphometry indicated a rapid bone formation during the first 10 days of the consolidation phase (BFRday15-25 = 0.14 ± 0.05 mm3/day), followed by callus reshaping via equivalent bone formation and resorption rates. The 4D time-lapse morphometry method developed in this study allows for a continuous quantitative monitoring of the dynamic process of bone formation and resorption following distraction, which may offer a better understanding of the mechanism for mechano-regulated bone regeneration and aid for development of new treatment strategies of DO.