Rigid External Distraction with Intranasal Bone-borne Traction Hooks for Midfacial Hypoplasia.

Rigid external distraction is currently performed to correct cases of severe maxillary hypoplasia. As an improvement of this technique, we propose the use of an intranasal bone-borne traction hook. This study is a retrospective chart review of the intranasal bone-borne traction hooks used in the treatment of severe maxillary hypoplasia. There were 110 patients treated with the hooks from 2005 to 2017. The maximum traction force was 7.75 kg, and there were few complications encountered during distraction. There were 76 patients who had the hooks removed under local anaesthesia. A cephalometric analysis was conducted in 56 patients. The average advancement of A-point was 9.9 ± 4.2 mm, 8.4 ± 2.5 mm, 11.0 ± 3.7 mm, 17.9 ± 4.4 mm for the trans-sutural distraction osteogenesis (DO), maxillary anterior segment DO, Le Fort I osteotomy DO and Le Fort III/II osteotomy DO, respectively. The average changes of sella-nasion-point A (SNA) were 8.89 ± 4.30 degrees, 8.21 ± 3.17 degrees, 10.49 ± 3.26 degrees, and 15.10 ± 4.00 degrees, respectively. The A point-nasion-B point (ANB) also showed increases in all procedures with P < 0.001. In conclusion, this technique sufficiently advances the midface and ensures the scars are concealed in the nasal base. The traction hook can bear a large traction force, causes minimal complications and is easily removed.

The Radiological and Stereological Analysis of the Effect of Low-Level Laser Therapy on the Mandibular Midline Distraction Osteogenesis.

OBJECTIVE: The aim of this study was to evaluate the effect of low level laser therapy (LLLT) on bone mineral density by using high-resolution computerized tomography (HR-CT) and stereology in patients subjected to mandibular midline distraction. METHODS: Nine patients between the ages of 13 and 16 years with mandibular transverse deficiency (>5 mm) were evaluated. Mandibular midline distraction osteogenesis was performed for all the patients. The patients were divided into 2 groups: the control group (n = 4) and the laser group (n = 5). GaAlAs, 830 nm wavelength, power of 40 mW, energy of 8.4 J/cm2 dose per spot, was directly applied from 2 points on the mandibular midline. The laser was applied in 8 treatment sessions at 48-hour intervals. Bone mineral density and volume of the newly formed bone were analyzed using HR-CT and stereological methods. RESULTS: A higher bone mineral density rate was found in the laser group (P < 0.05). A higher newly formed immature bone rate was found in the control group (P < 0.001). These findings suggest that more mature bone may also have a greater mineral organization than that of immature newly formed bone, which is shown by HR-CT and stereological results. CONCLUSIONS: The retention period can be shortened and mineralization may be increased by using LLLT in mandibular distraction osteogenesis.

Effects of the hyperbaric oxygen on de novo bone formation during periosteal distraction.

OBJECTIVE: The purpose of this study was to investigate the effect of hyperbaric oxygen (HBO) therapy on de novo bone formation during periosteal distraction (PD). MATERIALS AND METHODS: Periosteal distraction was performed in 24 mature male New Zealand rabbits using a custom-designed device placed on the lateral surface of the mandibular corpus. Twelve rabbits (group H) were given adjunctive HBO treatment, whereas 12 rabbits (group N) were kept in a normal environment (normobaric oxygen). After a 7-day latency period, the same distraction protocol was applied to both groups. However, the rabbits in group H were treated with pure oxygen at 2.4 atm absolute for 25 times. Both groups were further divided into 2 subgroups and killed after consolidation periods of 4 and 8 weeks. Photodensitometric and histologic analyses were performed to evaluate the newly formed bone. RESULTS: There was no significant difference between the 4-week consolidated HBO group and the 8-week consolidated normobaric oxygen subgroup (P = 0.229). Moreover, there was better bone formation in the 8-week HBO group than in the 8-week control group. CONCLUSION: The results of this study indicate that PD with HBO could be used to increase the quality and the quantity of the bone newly formed by PD.

Guide surgery osteotomy system (GSOS) a new device for treatment in orthognathic surgery.

INTRODUCTION: This article proposes an innovative and revolutionary diagnostic and therapeutic protocol for performing dentoalveolar osteotomies in office under local anaesthesia with piezoelectric surgery using a surgical acrylic guide produced through software-based planning. METHODS: The method was applied in the correction of crossbites, changing in the curve of Spee, incisal decompensations and dental ankylosis. Performing a preoperative CT with a special splint, optical scanning of the models and the subsequent planning with software has enabled us to produce a model with rapid prototyping with the design of the osteotomy on which the surgical guide was shaped, the use of the guide associated with piezoelectric surgery, allowed to perform surgery under local anaesthesia, with minimal invasiveness and high accuracy. RESULTS: Dentoalveolar immediate movements, with preservation of the roots of teeth involved, allow for rapid treatment of malocclusions which would be long and often difficult if not impossible to treat with orthodontics only. Dentoalveolar osteotomies associated to osteodistraction concepts, allow the orthodontist to achieve with accuracy the objectives required by the treatment plan. CONCLUSIONS: GSOS is a new method, which, utilizing 3D optical scanning images of models, software and piezoelectric surgery, allows to perform dentoalveolar movements which may be dangerous to the roots or for the periodontal support, with orthodontics only. It dramatically reduces total surgical-orthodontic treatment time, with obvious great patient satisfaction.

Femoral bone transport by a monolateral external fixator with or without the use of intramedullary nail: a single-department retrospective study.

BACKGROUNDS: Treatment for bone defect remains a challenge for orthopedists. Bone transport gives an effective alternative, which can be performed with an external fixator alone or combined with an intramedullary nail. Each has its advantages and disadvantages. We present a retrospective study to find out the optimal choice by evaluating the outcomes of treatment for femoral bone defect with two methods. METHODS: Two groups of patients, the monolateral external fixator alone (group A, n = 13) and the monolateral external fixator combined with intramedullary nail (group B, n = 15), were compared. Duration of the external fixator, external fixator index, radiographic consolidation index, complication, and total cost for treatment was also recorded. A modified classification of the Association for the Study and Application of the Method of Ilizarov (ASAMI) was used to assess results in two groups of patients; another SF-36 health survey questionnaire was used to assess the life qualities patients of two groups. RESULTS: Healing was achieved in 13/13 and 13/15 of the two groups, respectively. The rates of complications were significantly higher in the group A. Two patients performed amputations because of persistent deep infections in group B. Statistically significant difference was found when comparing ASAMI scores and categories of the SF-36 health survey. CONCLUSIONS: Bone transport by monolateral external fixator with the use of intramedullary nail reduces the incidence of complication and the duration of external fixator time that give patients a better life quality in both physical and emotional. However, if chronic osteitis exists, bone transport should be treated with monolateral external fixator alone due to a lower rate of amputations.

Infrared laser therapy after surgically assisted rapid palatal expansion to diminish pain and accelerate bone healing.

The aim of this study was to illustrate how gallium arsenite aluminum diode laser (824 nm) irradiation can reduce postsurgical edema and discomfort and accelerate sutural osseous regeneration after surgically assisted rapid palatal expansion (SARPE). An adult patient with an 8-mm transverse maxillary discrepancy was treated with SARPE. Infrared laser therapy was started on the 7th postoperative day, with a total of eight sessions at intervals of 48 hours. The laser probe spot had a size of 0.2827 cm2 and was positioned in contact with the following (bilateral) points: infraorbital foramen, nasal alar, nasopalatine foramen, median palatal suture at the height of the molars, and transverse palatine suture distal to the second molars. The laser was run in continuous mode with a power of 100 mW and a fluency of 1.5 J/cm2 for 20 seconds at each point. Subsequently, an absence of edema and pain was observed. Further, fast bone regeneration in the median palatal suture could be demonstrated by occlusal radiographs. These findings suggest that laser therapy can accelerate bone regeneration of the median palatal suture in patients who have undergone SARPE.

Transporte óseo en defecto óseo femoral. A propósito de un caso / Bone Transport for bone reconstruction. A case report

Objetivo: El transporte óseo es una técnica terapéutica que crea hueso en situaciones en las que la pérdida del mismo hace inviable la consolidación de los extremos. Esta técnica se basa en el concepto de osteogénesis en distracción. Material y método: Presentamos el caso de un varón de 31 años, que tras sufrir una fractura del tercio medio del fémur derecho, no se obtuvo la consolidación debido a la infección del foco tras varios intentos de osteosíntesis. Presentaba una pérdida de hueso severa con mal estado general. Resultados: Tras un tratamiento previo fallido, de unos dos años, se limpió el foco y, con la técnica de transporte óseo, se restauró la longitud inicial del hueso consolidándolo finalmente sin secuelas relevantes. Conclusión: El caso demuestra la validez de este método de transporte óseo para restaurar la longitud ósea en caso de grandes defectos diafisarios (AU)

Objetive: Bone transport is a therapeutic technique that generates bone in situations where bone loss makes consolidation of the extremities non-viable. This technique is based on the concept of distraction osteogenesis. Material and method: Following fracture of the middle third of the right femur in a 31-year-old male, consolidation was not achieved, due to focus infection after several osteosynthesis attempts. The patient presented severe bone loss with a poor general condition. Results: Following the previous failed treatment lasting about two years, the affected zone was cleaned, and the bone transport technique was used to restore the original length of the bone, which was finally consolidated without relevant sequelae. Conclusion: This case shows the validity of the bone transport technique in restoring bone length in the case of large diaphyseal defects (AU)

The effect of radiation in distraction osteogenesis for reconstruction of mandibular segmental defects.

Distraction osteogenesis is useful in the reconstruction of mandibular segmental defects. The effects of radiotherapy on distracted bone after resection of squamous cell carcinoma of the oral cavity are still unknown. We report the outcome in six patients who had distraction osteogenesis after postoperative radiotherapy. Distraction was by a unidirectional semi-buried device and panoramic radiographs were taken monthly during the distraction and consolidation periods to monitor the progress of the distraction. Follow-up ranged from 15 to 45 months (mean 33). The dose of radiation ranged from 60 to 70Gy. In one patient the bone was completely exposed and all the screws were loosened. There was no calcification and the gap remained radiolucent in the panoramic radiographs. The other five patients had excellent or good quality of bone. We conclude that radiotherapy may not interfere substantially with distraction osteogenesis although larger series the necessary.

The effect of irradiation and hyperbaric oxygenation (HBO) on extracellular matrix of the condylar cartilage after mandibular distraction osteogenesis in the rabbit.

The effects of irradiation and hyperbaric oxygenation (HBO) on the extracellular matrix of condylar cartilage after mandibular distraction were evaluated. Unilateral distraction was performed on 19 rabbits. Five study groups were included: control, low- and high-dose irradiation, and low- and high-dose irradiation groups with HBO. Additionally, four temporomandibular joints (TMJ) were used as control material. The high-dose irradiated animals were given in the TMJ 22.4 Gy/4 fractions irradiation (equivalent to 50 Gy/25 fractions). Low-dose irradiation group received a 2.2 Gy dosage. Two groups were also given preoperatively HBO 18 x 2.5ATA x 90 min. After a two-week distraction period (14 mm lengthening) and four-week consolidation period the TMJs were removed. Proteoglycan (PG) distribution of the extracellular matrix was evaluated using safranin O staining and collagen I and II using immunohistochemistry. The organization of fibrillar network was studied by polarized light microscopy. On the operated side of the control group and on the unoperated side in all, except for high-dose irradiated group, PG distribution and fibrillar network were normal appearing. In the irradiated groups, with or without HBO, the cartilaginous layer was partially or totally devoid of PG and the network structure was severely damaged. In conclusion, irradiation in conjunction with the pressure applied by distraction causes severe damage to extracellular matrix of condylar cartilage.

Osteodistraction of a previously irradiated mandible with or without adjunctive hyperbaric oxygenation: an experimental study in rabbits.

The purpose of this study was to analyse the effects of irradiation and hyperbaric oxygenation (HBO) on mandibular osteodistraction (OD). Eighteen rabbits were divided into three groups: 1. Irradiation (R), 2. Irradiation+HBO (R-HO), and 3. Control group (C). Animals of groups R and R-HO received in the mandible irradiation 22.4 Gy in four 5.6 Gy fractions (equivalent to 50 Gy/25 fractions). In addition, group R-HO was given HBO at 2.5 ATA for 90 min per day 18 times preoperatively. Unilateral osteotomy was made 1 month after completion of radiotherapy. After a 1 week latency period bone distraction was started at rate of 1 mm per day, continued for 2 weeks, and left to consolidate for 4 weeks. Amount of new bone was measured histomorphometrically from midsagittal sections. Area of new bone was equal in all groups. Bone was more mature and bone spicules better organized in group C than in groups R and R-HO. Cartilaginous cells were found in distracted bone in all groups but larger chondroid islands were evident only in group R. It seems that despite delayed bone formation, OD can be performed after radiotherapy. HBO had a beneficial effect on bone quality of a previously irradiated mandible.

Segmental mandibular reconstruction by microincremental automatic distraction osteogenesis: an animal study.

We investigated the reconstruction of a surgically created critical size mandibular defect in sheep using a newly developed automatic distraction device. The device has an implantable component, which is fixed to the mandible to allow the transfer of the transport disc across the created defect, and an external component which is mounted on the activation pump and secured away from the site of bone distraction. Compression of the bellows in the external component causes fluid to be forced through the connecting tube into the distraction component. Distraction at a rate of 1 mm over 24 h was achieved in six sheep. New bone generated at the site of the created defects both anterior (compression side) and posterior (tension side) to the transport disc and had similar radiodensity to the adjacent mandibular bone eight weeks after the completion of distraction.

Cranial vault expansion using transcutaneously activated magnetic implants.

The technique of distraction osteogenesis has not been widely used in the treatment of problems of the head and face because of the need for external fixators. By using magnetic, rather than mechanical, forces to drive bone movement we hope to expand the applications of the technique to include the treatment of cranial vault deformities. Thirty immature rabbits were studied. Twenty-six of the rabbits underwent operations. Each of the 26 had 2 magnets fixed to its skull: one on the left parietal bone and one on the right parietal bone. Incomplete circumferential osteotomies were then performed around each magnet on 13 of the rabbits. A head frame was attached to each animal. Head frames without magnets were placed on 6 of the rabbits (3 with osteotomy, 3 without osteotomy) while 20 of the animals (10 with osteotomy, 10 without osteotomy) had 2 magnets mounted on the frames which were of opposite polarity to those implanted. The remaining 4 rabbits served as nonoperative controls. Six weeks later all of the animals were sacrificed. There were significant differences in the cranial volumes and contours between the groups of animals. Many of the differences were increased by coincident osteotomy. Associated histologic findings are described.

Effect of methotrexate on distraction osteogenesis.

To assess the potential of using distraction osteogenesis to reconstruct bone deficient limbs after limb salvage for musculoskeletal sarcomas, the authors examined the effect of methotrexate on distraction osteogenesis in a rabbit tibial lengthening model. Eighteen rabbits underwent tibial corticotomy and application of a ring external fixator. Rabbits were assigned randomly to one of two groups in which either methotrexate (n = 12) or placebo (n = 6) was administered during a 21-day distraction period. Serum methotrexate levels and complete blood cell counts were monitored during distraction, and radiographs of the tibia were obtained weekly. Half of the animals from each group were sacrificed at the end of distraction, and the remaining animals were sacrificed after 6 weeks of neutral fixation when bone normally bridges the gap. Using methotrexate at serum concentrations similar to those used clinically for the treatment of human osteosarcomas, the authors were unable to show significant radiographic, histologic, or chemical differences in the effect of this antineoplastic drug on distraction osteogenesis in the rabbit model.

[Standardized ultrasound follow-up of callus distraction of the mandible]. / Standardisierte sonographische Verlaufskontrolle bei der Kallusdistraktion am Unterkiefer.

Up to now the clinical follow-up in mandibular callus distraction was supported by radiologic methods, although low-mineralized structures are only insufficiently described by X-rays. Mandibular callus distraction was performed on 14 patients suffering from uni- or bilateral mandibular hypoplasia, using either intra- or extraoral devices. The clinical follow-up was supplemented by standardized sonographic investigations. With the exception of postoperative pin placement control, which was done by using X-rays, all interesting items of treatment could be visualized by sonography. We found a reliable correlation between sonographically measured distances and distances measured on the device. Due to early detection of complications, a premature ossification was detected in one case and an infection was diagnosed in another, using ultrasound. Sonography proved to enhance the possibilities of monitoring in mandibular callus distraction treatment and can be recommended in clinical routine.

[Mandibular distraction using a dynamic osteosynthesis system: MD-DOS. Concepts and surgical technic]. / Un système de distraction mandibulaire par ostéosynthèse dynamique: DM-SOD. Concept et technique chirurgicale.

MD-DOS (mandibular distraction with a dynamic osteosynthesis system) is an intra-oral mandibular distractor that can be placed via the oral route, enabling application under local anesthesia. The aim of the article is to describe the technical-surgical aspects of the treatment concept, based on an initial experience of 35 cases. The device is characterised by a single horizontal posterior fixation screw-implant, a vertical hinge that copes with the lateral force vector in the condyles, a telescopic distraction module, and an anterior fixation unit that is fixed with monocortical screws. The main indication was mandibular lengthening in Angle Class II, deep bite cases. The third molars could be removed in the same session. Of importance was the horizontal placement of the posterior fixation unit (PFU), together with the distraction module, in order not to interfere with lateral jaw movements and with the lower sulcus. Equally important was the use of at least one 7.5 mm long osteosynthesis screw together with at least three 5.5 mm screws. Near complete mobilisation of the segments, firmly blocking the posterior fixation unit with the vertical hinge in a perpendicular position, and placing MD-DOS as close as possible to the dental arch, were also important parameters for success.