CallusmassageA new treatment modality for non-unions of the irradiated mandible

Abstract

Recent reports on orthopaedic surgery focus on mechanical stimulation of the regenerate during distraction therapy of non-unions in long-bone-surgery. In the field of maxillofacial surgery, callus stimulating techniques are rarely reported. The case of a 65-year-old man with a radiogenic mandibular non-union after ablative tumour therapy and pre-operative radiation therapy presented with a non-union. Vertical distraction in combination with subsequent repeated, stepwise compression and distraction (=massage) had a positive effect on the consolidation of the regenerate.

Indications and surgical technique for distraction osteogenesis of the alveolar bone for augmentation prior to insertion of dental implants

“…Compression continues in the callus of tensile and shear forces, whereupon a cascade of osteogenic factors and cytokines is activated 29–31 . Callus compression should be applied intermittently 9 . An experimental study showed that the number of osteoblasts and vessels was highest with intermittent compression.…”

“…In regards to the distraction rhythm, there is a broad variation, from 1 to 4 times per day, spreading the daily frequency in equal periods 15 . Different statements are made about the optimal time required for the consolidation phase 9 . Depending on the extent of the distraction distance, a healing time of up to 12 weeks is given for the consolidation phase, at the earliest 4–6 weeks 9,18 .…”

“…The bone regeneration mechanism on which ADO is based is that between two osteotomized bone segments of the alveolar bone, the existing callus tissue is significantly increased by slow distraction in several small steps. Compared to normal fracture healing, the vascularization of the stretched callus takes place about 10 times faster, which leads to an up to 4 times increased bone apposition rate (4.2 μm instead 1.6 μm) per day 9 . After completion of the distraction period, during the subsequent consolidation of 2 to 3 months, the mobilized tissue is converted into hard callus (fibrous bone) 10,11 .…”

“…Compared to normal fracture healing, the vascularization of the stretched callus takes place about 10 times faster, which leads to an up to 4 times increased bone apposition rate (4.2 μm instead 1.6 μm) per day. 9 After completion of the distraction period, during the subsequent consolidation of 2 to 3 months, the mobilized tissue is converted into hard callus (fibrous bone). 10,11 However, due to the biological background of the procedure, the implants can also be placed at an earlier time, after about 1-2 months.…”

Pumping the Periosteum: A Feasibility Study

“…The active dynamization or "accordion maneuver" was successfully used in long bones to reduce the duration of treatment [6][7][8] or enhance the formation of bony union at the docking site. 9,10 The alternation protocol performed during [11][12][13][14] or after the mandibular DO 13,15 was superior compared with conventional DO protocol in terms of mineralization and thickness of the forming cortical bone. In contrast, an interruption of distraction by 2 days of compression showed no substantial difference in histological or radiological appearances in the mandible of rats.…”