Distraction Osteogenesis of the Craniofacial Skeleton

Abstract

LEARNING OBJECTIVES:: After studying this article, the participant should be able to: 1. Review the biomechanical principles and pertinent cellular and molecular biology of distraction osteogenesis of the craniofacial skeleton. 2. Describe the clinical indications and applications of distraction osteogenesis of the craniofacial skeleton. 3. Describe maxillary, mandibular, midface, and calvarial procedures in distraction osteogenesis. 4. Discuss the clinical outcomes and complications of distraction osteogenesis of the craniofacial skeleton.The year 2002 marked the end of the first decade in clinical distraction osteogenesis of the craniofacial skeleton. In this short period, its application has increased exponentially. More than 3000 cases have been performed according to a recent survey, and more than 700 articles have been written on this subject in the MEDLINE database since 1996. It is a powerful surgical tool and enables surgeons to achieve results not previously attainable. Despite all this, distraction osteogenesis is practiced by only a small number of plastic surgeons. This article reviews the biomechanical principles; the pertinent cellular and molecular biology; and the clinical indications, applications, controversies, and complications of distraction osteogenesis of the craniofacial skeleton.

Biomechanical Assessment of Regenerate Integrity in Irradiated Mandibular Distraction Osteogenesis

“…[1][2][3][4] Distraction osteogenesis is a formidable tool for reconstructing mandibular defects. The primary application of mandibular distraction osteogenesis has been in the setting of congenital mandibular deformities [23][24][25] ; however, the use of this powerful technique for tissue replacement after oncologic resection or as a reconstructive option for deformations secondary to irradiated bone could have immense potential therapeutic ramifications. Although a small number of anecdotal clinical cases have been reported, the results have contradicted each other, ranging from complete failure 11,12 to adequate union in five of six patients 10 and one case of mandibular distraction osteogenesis following radiation therapy union after hyperbaric oxygen therapy.…”

Bilateral squamosal suture synostosis: A rare form of isolated craniosynostosis in Crouzon syndrome

“…Distraction techniques have been shown to reduce operating time, reduce blood loss, reduce infection, eliminate need of bone graft, and allow for large advancement of the midface. Class Ⅲ malocclusion which is commonly seen in syndromic craniosynostosis patients is corrected at skeletal maturity with a Lefort I advancement or double jaw surgery [26][27][28][29][30][31][32] . In a conclusion, although squamosal suture craniosynostosis is an extremely rare entity, especially when associated with Crouzon syndrome, it is extremely important for the radiologist to be familiar with its radiological appearance in order to prevent misdiagnosis and delayed treatment.…”

Extracellular Signal-Related Kinase and Bone Morphogenetic Protein Expression during Distraction Osteogenesis of the Mandible: In Vivo Evidence of a Mechanotransduction Mechanism for Differentiation and Osteogenesis by Mesenchymal Precursor Cells

“…16 Utilizing mechanical force, distraction osteogenesis can rapidly induce and direct bone and soft-tissue formation in a variety of clinical scenarios. 17 Mechanical strain plays a unique role in upregulating the cellular processes of osseous regeneration. These fundamental molecular pathways in distraction osteogenesis share many comparable processes during early skeletal development.…”