Tracheostomy was prevented in 25 (96%) of 26 patients, and decannulation after distraction was possible in 38 (92%) of 41 patients. Success, defined as decannulation within 1 year of the start of distraction or prevention of tracheostomy in a patient otherwise deemed as a candidate, was found in 63 (94%) of 67 patients. Oral feedings have been resumed in 61 (91%) of 67 patients.Complications observed were mostly related to pin site infections requiring antibiotics. Device failure was experienced in 2 (3%) of 66 internal devices and in 7 (10.2%) of 68 external devices.Distraction osteogenesis of the mandible provides an excellent treatment for mandibular airway obstruction in patients younger than 6 years who do not respond to conservative measures and allows for early decannulation in patients who previously underwent tracheotomy.

An aortojejunal fistula is a possible long-term complication of endovascular treatment of abdominal aortic aneurysm. An explantation of the infected graft and aortic replacement by a cryopreserved allograft is a valuable surgical treatment.

This study was designed to investigate the optimal combination of known osteogenic biomaterials with shape conforming struts to achieve calvarial vault reconstruction, using a canine model. Eighteen adolescent beagles were divided equally into 6 groups. A critical-size defect of 6 x 2 cm traversed the sagittal suture. The biomaterials used for calvarial reconstruction were demineralized perforated bone matrix (DBM), recombinant human bone morphogenetic protein 2 (rhBMP2), and autogenous platelet-rich plasma (PRP). The struts used were cobalt chrome (metal) or resorbable plate. The groupings were as follows: 1) DBM + metal, 2) DBM + PRP + metal, 3) DBM + PRP + resorbable plate, 4) DBM + rhBMP2 + metal, 5) DBM + rhBMP2 + PRP + metal, and 6) DBM + rhBMP2 + resorbable plate. Animals were killed at 3 months after surgery. There was no mortality or major complications. Analysis was performed macroscopically and histologically and with computed tomography. There was complete bony regeneration in the rhBMP2 groups only. Non-rhBMP2 groups had minimal bony ingrowth from the defect edges and on the dural surface, a finding confirmed by computed tomographic scan and histology. Platelet-rich plasma did not enhance bone regeneration. Shape conformation was good with both metal and resorbable plate. rhBMP2, but not PRP, accelerated calvarial regeneration in 3 months. The DBMs in the rhBMP2 groups were substituted by new trabecular bone. Shape molding was good with both metal and resorbable plate.