RESUMO
BACKGROUND: Total hip arthroplasty (THA) for dislocated hips (Crowe IV dysplasia) presents unique challenges. Conventional approaches involve subtrochanteric osteotomies, but are complex with additional fixation and potentially lead to limb length discrepancies, nerve palsies, and other complications. An alternative strategy is a staged approach, where the femoral head (or remnant) is gradually lowered (distraction technique) to align with the true acetabulum over a period of time, followed by a second-stage anatomically acetabular-positioned THA. External fixation distraction and telescoping internal lengthening devices have been utilized to achieve preoperative alignment. We evaluated these techniques, including the types, time, and amount of distraction needed, as well as outcomes and complication rates. METHODS: In this retrospective case series, 14 patients (9 women, 5 men), who had a mean age of 32 years (range, 16 to 67), underwent staged surgical interventions using hip distraction using external fixators or internal lengthening devices for hip dysplasia and other pathologies (Perthes disease, osteonecrosis) in preparation for a second-stage anatomically placed THA. The mean follow-up duration for external-fixation patients was 10 years (range, 6.5 to 13.4). RESULTS: Staged treatment involved external fixators (n = 8) or internal lengthening devices (n = 6) with a device placement mean of 48 days (range, 42 to 71). The amount of distraction ranged from 6 to 12 cm. There were 2 patients who required uncomplicated revision of the internal lengthening devices, and another patient had a temporary peroneal nerve palsy. There was 1 patient who underwent an acetabular revision at 7 years. CONCLUSIONS: We focused on a challenging patient cohort that emphasizes the efficacy of staged interventions in managing Crowe Type IV dysplasia and similar cases. Favorable outcomes were found with the immediate transition to THA after device removal that effectively addressed soft-tissue contractures and femoral migration. Despite the need for further validation via larger, prospective studies, this innovative approach may pave the way toward optimizing this strategy for these difficult hip pathologies.
Assuntos
Artroplastia de Quadril , Osteogênese por Distração , Humanos , Artroplastia de Quadril/instrumentação , Artroplastia de Quadril/métodos , Feminino , Masculino , Estudos Retrospectivos , Pessoa de Meia-Idade , Adulto , Adolescente , Idoso , Osteogênese por Distração/instrumentação , Osteogênese por Distração/métodos , Adulto Jovem , Resultado do Tratamento , Displasia do Desenvolvimento do Quadril/cirurgia , Fixadores Externos , Acetábulo/cirurgia , Articulação do Quadril/cirurgiaRESUMO
At present, stock linear distractors are used for internal maxillary distraction osteogenesis. However, the authors' research group has demonstrated, through an in silico analysis, that linear distraction leads to bone deformities and malocclusion, whereas helical distraction can yield ideal outcomes. A system for designing and manufacturing custom helical distractors has recently been developed, and the feasibility of these appliances now needs to be assessed. This study was, therefore, conducted to gain an initial insight into their feasibility. The study had two goals. First, it aimed to demonstrate, in an in vitro model, that the novel system of custom helical distraction can produce appropriate clinical outcomes. The second aim was to compare the performance of custom helical distractors with that of stock devices and hybrid devices (i.e., linear appliances that feature patient-specific footplates). Interpreting the results as trends, this study showed that the system of custom helical distraction resulted in in vitro outcomes that were superior to those obtained with stock and hybrid devices.
Assuntos
Estudos de Viabilidade , Maxila , Osteogênese por Distração , Humanos , Osteogênese por Distração/instrumentação , Osteogênese por Distração/métodos , Maxila/cirurgia , Técnicas In Vitro , Desenho de EquipamentoRESUMO
The purpose of this study was to determine the stiffness of mandibular soft tissues during mandibular distraction, from the perspective of improving distraction devices such as automated continuous distractors. Uncompleted osteotomy was performed on 11 fresh human hemimandibles via a greenstick fracture, to preserve the uplift of the internal periosteum of the mandibular corpus. In order to replicate continuous distraction, direct measurements were performed through a uniaxial quasi-static tensile test. For all specimens, linear regression was applied to the force-displacement curve for a force region of 10-20 N, and the slope extracted. The mean stiffness was estimated to be 9.12 ± 3.56 N/mm. This study is the first to measure directly the stiffness of the surrounding tissues of the human mandibular corpus, and paves the way to the design of a new generation of distractor devices.
Assuntos
Mandíbula , Osteogênese por Distração , Humanos , Osteogênese por Distração/instrumentação , Osteogênese por Distração/métodos , Mandíbula/cirurgia , Fenômenos Biomecânicos , Resistência à Tração , Estresse Mecânico , Cadáver , Masculino , Pessoa de Meia-Idade , Feminino , IdosoRESUMO
Treatment of children with Pierre Robin sequence (PRS) having a hypoplastic mandible and upper airway distress after birth may consist of external distraction devices. Shape anomalies of the permanent molars and positional changes due to surgery have been documented. The aim of this study is to compare the long-term effects (>5 years) on the growth pattern of PRS-patients treated with an external mandibular distraction device with no-surgery cases and to investigate the dental development or damage. A retrospective cohort study was performed. PRS-patients with and without surgery were included. A digital cephalometric analysis was made to evaluate the growth pattern of the mandible between groups as well as with normal values. Nine of 19 patients underwent an external mandibular distraction. All children were extubated after 4-5 days with no signs of respiratory distress. Screw and device loosening presented in one patient. The articular and sellar angles were significantly larger and smaller, respectively, in the Surgery group. Mandibular distraction surgery might result in a 'growth boost' compared to the No-surgery group. No significant difference in dental development was found. Mandibular distraction osteogenesis is an effective way of relieving severe upper airway obstruction.
Assuntos
Cefalometria , Mandíbula , Osteogênese por Distração , Síndrome de Pierre Robin , Humanos , Síndrome de Pierre Robin/cirurgia , Osteogênese por Distração/métodos , Osteogênese por Distração/instrumentação , Estudos Retrospectivos , Feminino , Mandíbula/cirurgia , Masculino , Criança , Pré-Escolar , Lactente , Resultado do Tratamento , Obstrução das Vias Respiratórias/cirurgiaRESUMO
Limb lengthening relies on the process of distraction osteogenesis. The active periosteal bone formation has been detected in clinical practice with a lengthening and then nail (LATN) technique but has not been confirmed by experimental studies to date. The aim of this study is to compare the tissue regeneration of the distraction regenerate during tibial lengthening in rabbits using a LATN technique. This study was performed on 54 mature rabbits of the Soviet Chinchilla breed, which were divided into three groups of 18 animals. In group 1 (control), the tibia was lengthened in an external fixator. In group 2, the LATN technique was modeled and in group 3, lengthening over nail (LON) was modeled. The total duration of the experiment was 45 days. On the 10th, 15th, 20th, 30th, and 45th day X-ray, computed tomography and morphological studies were performed. In the experimental groups (2 and 3), a more pronounced periosteal bone formation in the area of regenerate was noted when compared to group 1. In group 2 (LATN), wide cortical plates were formed from the intermediate and periosteal areas. In this group, the maximum densitometric density values were noted. Endosteal bone formation was preserved in all groups. The LON and LATN techniques, when compared with the classical Ilizarov lengthening, do not demonstrate any deficiency in the tissue regeneration of the bone tissue at the regenerate sites. The most powerful bone structures are formed with the sequential use of the external fixation and nailing (LATN).
Assuntos
Pinos Ortopédicos , Fixadores Externos , Osteogênese por Distração , Tíbia , Animais , Coelhos , Osteogênese por Distração/métodos , Osteogênese por Distração/instrumentação , Tíbia/cirurgia , Regeneração Óssea , Alongamento Ósseo/métodos , Alongamento Ósseo/instrumentação , Periósteo/cirurgia , MasculinoRESUMO
BACKGROUND: Rapid distraction of the periodontal ligament is an effective method to shorten the orthodontic treatment time. The objectives of the present study were to assess the effects of an HYCON device (Adenta GmbH, Germany) on the rate of en masse retraction of the anterior teeth, duration of retraction, anchorage loss, root resorption, and soft tissue changes. METHODS: This study was conducted on 60 female patients aged >18 years, divided randomly into two equal groups: Group 1 comprised 30 patients with HYCON, and group 2 comprised 30 patients with nickel-titanium closed coil springs. Skeletal, dental, and soft tissue changes were evaluated on pre- and post-retraction lateral cephalograms, and the rates of anterior tooth movement and anchorage loss were assessed monthly on the dental casts of the patients. Root resorption was assessed using intraoral periapical radiograph. Student's t test was used for the analysis of parametric data, and the Mann-Whitney U test was used for nonparametric data. RESULTS: HYCON significantly shortened the retraction duration by 3 months. The rate of anterior teeth retraction was two times faster in group 1, compared with group 2. There was a significant difference in the anchorage loss between the groups in only first 2 months of treatment. Group 2 showed significantly more root resorption and soft tissue changes than group 1 (P < 0.05). CONCLUSIONS: HYCON is an effective device for significantly shortening the duration of retraction with anchorage loss of 2 to 2.5 mm. However, careful monitoring for possible root resorption should be performed.
Assuntos
Procedimentos de Ancoragem Ortodôntica , Ligamento Periodontal , Reabsorção da Raiz , Técnicas de Movimentação Dentária , Humanos , Feminino , Técnicas de Movimentação Dentária/instrumentação , Técnicas de Movimentação Dentária/métodos , Reabsorção da Raiz/etiologia , Procedimentos de Ancoragem Ortodôntica/instrumentação , Procedimentos de Ancoragem Ortodôntica/métodos , Cefalometria , Incisivo , Adulto Jovem , Adulto , Adolescente , Osteogênese por Distração/instrumentação , Osteogênese por Distração/métodos , Fios Ortodônticos , Desenho de Aparelho Ortodôntico , Níquel , Fatores de Tempo , TitânioRESUMO
PURPOSE: The aim of this study was to evaluate the effect of combining a bone-borne palatal expander (distractor) with a maxillary osteotomy in the treatment of narrowed maxillae in treated cleft palate patients. Few articles in the literature isolated the effects of transpalatal distraction in cleft patients and most either excluded cleft patients or grouped them with non-cleft patients. The hypothesis is that the use of a bone-borne palatal expander in conjunction with a maxillary osteotomy would improve the amount of maxillary expansion at the anterior segment with less tipping of the segments and provide a harmonious arch form. METHODS: We studied four patients above 14 years of age with repaired cleft palate and progressive anterior constriction of the arch. All patients received a bone-borne distractor (UNI-Smile Distractor, Titamed, Belgium) combined with a LeFort I level osteotomy without pterygomaxillary disjunction. Dental models and CBCT measurements were used to analyze the skeletal and dental effects of the intervention. RESULT: All the patients who completed the trial had satisfactory expansion and normalization of the maxillary arch form. The average increase in the intercanine distance was 12.9 mm while the average increase in the intermolar distance was 7.2 mm. No significant change in molar inclination or buccal bone thickness was observed. CONCLUSION: The use of bone-borne palatal expanders aided by a maxillary osteotomy (transpalatal distraction) in treated cleft palate patients can provide a harmonious arch form in adolescent and adult patients. This trial was registered in the clinical trials registry with the ID NCT03837652 on February 12, 2019.
Assuntos
Fissura Palatina , Osteogênese por Distração , Técnica de Expansão Palatina , Adolescente , Feminino , Humanos , Masculino , Fissura Palatina/cirurgia , Fissura Palatina/diagnóstico por imagem , Tomografia Computadorizada de Feixe Cônico , Maxila/cirurgia , Maxila/anormalidades , Osteogênese por Distração/métodos , Osteogênese por Distração/instrumentação , Osteotomia de Le Fort/métodos , Técnica de Expansão Palatina/instrumentaçãoRESUMO
OBJETIVOS: Mostrar resultados, complicaciones y lecciones aprendidas utilizando el clavo intramedular magnético (IML, Intramedullary Magnetic Lengthener) en un grupo de pacientes sometidos a alargamiento óseo. PACIENTES Y MÉTODOS: Entre enero 2017 y diciembre 2019, 9 pacientes (15 segmentos), edad entre 15 y 39 años, fueron sometidos a alargamiento óseo con IML: 5 pacientes tuvieron alargamiento femoral bilateral por talla baja, 1 paciente se sometió a alargamiento de Piernas bilateral por Tibia vara y acortamiento mesomélico y 3 recibieron alargamientos femorales unilaterales por discrepancia de longitud de extremidades. Todos fueron operados por el mismo cirujano, con técnica standard. Se indicó kinesiterapia al menos 5 veces por semana durante la fase de distracción. RESULTADOS: En todos se logró el objetivo de alargamiento planteado. No hubo complicaciones intra ni postoperatorias graves (TVP, TEP, Embolia grasa), ni fallas del sistema distractor. Un paciente desarrolló contracturas articulares de ambas rodillas por no adhesión a Kinesiterapia. Ninguno requirió aporte de injerto óseo, sin embargo en 2 pacientes de alargamiento de Fémur bilateral, se presentó deformidad en varo, que hizo necesario recambio a clavo convencional y un paciente desarrolló una parálisis transitoria del Nervio Peroneo común. CONCLUSIONES: El advenimiento de los IML significó un gran avance en el campo de la osteogénesis por distracción, sin embargo, aún se trata de un procedimiento complejo, que debe ser planificado cuidadosamente para minimizar los riesgos y complicaciones. Una selección meticulosa del paciente y la evaluación física y psicológica previa, son fundamentales para el éxito del procedimiento. Los casos bilaterales requieren de un seguimiento cercano, por el riesgo de falla del implante.
objective: We show our results, complications and lessons learned using the Intramedullary Magnetic Lengthener (IML) in a group of patients who were subjected to bone lengthening. PATIENTS AND METHODS: Between January 2017 and December 2019, 9 patients (15 segments), aged between 15 and 39 years, underwent bone lengthening with IML: 5 patients had bilateral femoral lengthening due to short stature, 1 patient had bilateral leg lengthening due to Tibia vara and mesomelic shortening and 3 had unilateral femoral lengthening for limb length discrepancy. All were operated by the same surgeon, with standard technique. Physical therapy was indicated at least 5 times per week during the distraction phase. RESULTS: In every case, the proposed lengthening amount was achieved. There were no serious intraoperative or postoperative complications (DVT, Pulmonary Embolism, Fat Embolism), nor failures of the distractor system. One patient developed knee joint contracture due to non-adherence to Physical therapy. None required bone grafting, however, in 2 patients with bilateral Femur, a varus deformity appeared, which required nail exchange with a conventional trauma nail. One case developed a transit common Peroneal Nerve palsy. CONCLUSIONS: IMLs represent a great advance in the bone lengthening realm, however, it is still a complex procedure, which must be carefully planned to minimize risks and complications. Meticulous patient selection and prior physical and psychological evaluation are essential to the success of the procedure. Bilateral cases need a closer follow up, because implant failure is a potential risk.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Adulto Jovem , Alongamento Ósseo/métodos , Pinos Ortopédicos , Fixação Intramedular de Fraturas/métodos , Complicações Pós-Operatórias , Alongamento Ósseo/instrumentação , Resultado do Tratamento , Osteogênese por Distração/instrumentação , Osteogênese por Distração/métodos , Fêmur , Fixação Intramedular de Fraturas/instrumentação , Desigualdade de Membros InferioresRESUMO
Objective: The objective of this study was to evaluate the biomechanical effect of mandibular corpus distraction osteogenesis with different orientations and rates. Materials and Methods: A three-dimensional model of the mandible was created. The vertical surgical cut was made, the force was applied horizontally in a bidirectional manner within two orientations: parallel to the occlusal plane and parallel to the inferior border of the mandible with three rates (0.5mm, 1mm and 1.5mm). Results: The maximum values for von Mises stress when the force was applied parallel to the inferior border of the mandible with all three rates were smaller than those with force direction parallel to the occlusal plane. The displacement in all three directions x, y, and z were not parallel and prominent in the anterior part of the mandible, while the movement at the posterior part is negligible, x and z displacement were bigger when force was applied parallel to the inferior border of the mandible, z displacement was more prominent than x and y displacement, both directions produced upward rotation of the mandible, this rotation was more noticeable when the force was applied parallel to the inferior border of the mandible. Conclusions: A vertical cut can be used in the patient with a long anterior face. This site of distraction achieves more lengthening of mandible than expansion.
Assuntos
Humanos , Osteogênese por Distração/instrumentação , Osteogênese por Distração/métodos , Mandíbula , Migração de Dente , Impressão TridimensionalRESUMO
La micrognatia e hipoplasia unilateral mandibulares son un rasgo característico en algunos síndromes que incluyen defectos faciales, pero también se pueden presentar como secuelas de traumatismo sobre los tejidos duros del complejo maxilofacial. Dichas alteraciones adquiridas o congénitas, ocasionan grandes trastornos estéticosy funcionales. La distracción ósea descrita por Ilizarov como un método de elongación de los huesos largos, aplicado al área maxilofacial en años recientes, ha demostrado ser una técnica eficaz para la corrección de estos defectos. En este artículo se reportan tres casos de corrección de deformidades mandibulares en niños mediante la técnica de distracción ósea utilizando aparatos reabsorbibles, siendouna de sus ventajas el que no se requiere una segunda intervenciónquirúrgica para su retiro. Los pacientes fueron intervenidos en la Unidad Médica de Alta Especialidad (UMAE) No. 71 del Instituto Mexicano del Seguro Social, en donde desde hace 10 años se ha estadoutilizando el método de distracción ósea para manejo de deformidades mandibulares en niños con muy buenos resultados.
Mandibular micrognathia and unilateral mandibular hypoplasia are atypical feature of certain facial deformity syndromes, though can alsoappear as sequelae of maxillofacial hard tissue trauma. Acquired orcongenital alterations of this nature can have a signifi cant aestheticand functional impact. Ilizarov describes distraction osteogenesis as amethod for lengthening long bones, one that in recent years has beenapplied to the maxillofacial region and proved an eff ective technique forcorrecting these defects. This article reports three cases of mandibulardeformity correction in children, carried out using the distraction osteogenesistechnique with resorbable devices. One of the advantagesof using such devices is that the need for a second surgical interventionto remove them is eliminated. All patients were treated at AdvancedSpecialty Medical Unit (UMAE) 71 of the Mexican Institute of SocialSecurity, which, for the last ten years, has been using the distractionosteogenesis method to correct mandibular deformities in children,with optimal results.
Assuntos
Humanos , Masculino , Adolescente , Feminino , Pré-Escolar , Criança , Micrognatismo/cirurgia , Osteogênese por Distração/instrumentação , Osteogênese por Distração/métodos , Implantes Absorvíveis , Assimetria Facial/cirurgia , Estética Dentária , MéxicoRESUMO
INTRODUCTION: Distraction Osteogenesis (DO) became an alternative for the treatment of severe craniofacial skeletal dysplasias. The rigid external distraction device (RED) is successfully used to advance the maxilla and all the maxillary-orbital-frontal complex (monobloc) in children, adolescents and adults. This approach provides predictable and stable results, and it can be applied alone or with craniofacial orthognathic surgical procedures. OBJECTIVE: In the present article, the technical aspects relevant to an adequate application of the RED will be described, including the planning, surgical and orthodontic procedures.
INTRODUÇÃO: a Distração Osteogênica (DO) tornou-se uma alternativa para o tratamento das displasias craniofaciais esqueléticas severas. O aparelho distrator externo rígido (RED) é utilizado com êxito para avançar a maxila e todo o complexo maxilar-orbital-frontal (monobloco) em crianças, adolescentes e adultos. Essa abordagem proporciona resultados previsíveis e estáveis, podendo ser aplicada isoladamente ou junto a procedimentos cirúrgicos ortognáticos craniofaciais. OBJETIVO: no presente artigo, serão descritos os aspectos técnicos pertinentes a uma adequada aplicação do RED, incluindo o planejamento, procedimentos cirúrgicos e ortodônticos.
Assuntos
Adolescente , Adulto , Criança , Humanos , Fenda Labial/complicações , Fissura Palatina/complicações , Fixadores Externos , Maxila/anormalidades , Desenho de Aparelho Ortodôntico/métodos , Procedimentos Cirúrgicos Ortognáticos/métodos , Osteogênese por Distração/instrumentação , Maxila/cirurgia , Osteogênese por Distração/métodos , SíndromeRESUMO
Distraction osteogenesis (DO) is a surgical technique producing bone lengthening by distraction of the fracture callus. Although a large number of experimental studies on the events associated with DO of craniofacial skeleton have been reported, the few employing rat mandibular bone DO used complicated designs and produced a small volume of newly formed bone. Thus, this study aims to present an original experimental model of mandibular DO in edentulous rats that produces a sufficient quantity and quality of intramembranous bone. Eight male Wistar rats, weighing 75 g, underwent extraction of lower molars. With rats weighing 350 g, right mandibular osteotomy was performed and the distraction device was placed. The distraction device was custom made using micro-implants, expansion screws, and acrylic resin. Study protocol: latency: 6 days, distraction: » turn (0.175 mm) once a day during 6 d, consolidation: 28 d after distraction phase, sacrifice. DO-treated and contralateral hemimandibles were dissected and compared macroscopically and using radiographic studies. Histological sections were obtained and stained with H&E. A distraction gap filled with newly formed and mature bone tissue was obtained. This model of mandibular DO proved useful to obtain adequate quantity and quality of bone to study bone regeneration.
Assuntos
Animais , Masculino , Ratos , Regeneração Óssea/fisiologia , Mandíbula/cirurgia , Osteogênese por Distração/métodos , Modelos Animais , Mandíbula/anatomia & histologia , Boca Edêntula , Osteotomia , Osteogênese por Distração/instrumentação , Ratos Wistar , CicatrizaçãoRESUMO
OBJECTIVE: We describe a new technique for removing the distal fragments of broken intramedullary femoral nails without disturbing the nonunion site. METHODS: This technique involves the application of an AO distractor prior to the removal of the nail fragments, with subsequent removal of the proximal nail fragment in an anterograde fashion and removal of the distal fragment through a medial parapatellar approach. Impaction of the fracture site is then performed with a nail that is broader than the remaining fragmented material. RESULTS: Nails were removed from five patients using the technique described above without any complications. After a mean follow-up period of 61.8 months, none of these patients showed worsened knee osteoarthritis. CONCLUSION: The original technique described in this article allows surgeons to remove the distal fragment of fractured femoral intramedullary nails without opening the nonunion focus or using special surgical instruments.
Assuntos
Adulto , Feminino , Humanos , Masculino , Adulto Jovem , Pinos Ortopédicos , Remoção de Dispositivo/métodos , Fraturas do Fêmur/cirurgia , Fixação Intramedular de Fraturas/instrumentação , Articulação do Joelho , Osteogênese por Distração/instrumentação , Pseudoartrose/terapia , Seguimentos , Fraturas do Fêmur , Fixação Intramedular de Fraturas/métodos , Osteogênese por Distração/métodos , Pseudoartrose , Resultado do Tratamento , Adulto JovemRESUMO
A Síndrome de Crouzon é uma doença hereditária que surge com o fechamento prematuro das suturas da base do crânio, resultando em um crescimento compensatório na direção em que as suturas permanecem abertas. A síndrome é caracterizada por deformidade craniofacial com redução do comprimento das bases anterior e posterior do crânio, tendo como principais características clínicas a exoftalmia, hipertelorismo e a hipoplasia do terço médio da face. / Objetivo / Relatar os casos clínicos de uma família, onde três de seus membros são portadores da Síndrome de Crouzon, apresentando, assim, as características clínicas e as formas de tratamento. / Relato / No caso 1, a paciente foi submetida à cirurgia de avanço frontofacial convencional; e nos casos 2 e 3, os pacientes foram submetidos ao avanço frontofacial com distração osteogênica. Todos foram operados em idade precoce, necessitando de tratamento ortodôntico e cirúrgico para finalização do caso. / Conclusão / Os tratamentos cirúrgico, ortopédico e ortodôntico são uma combinação perfeita para a correção das deformidades craniofaciais, sendo a distração osteogênica do terço médio da face uma técnica cirúrgica de grande sucesso, que apresenta menor morbidade e excelentes resultados.
Assuntos
Humanos , Masculino , Feminino , Criança , Adulto , Craniossinostoses/terapia , Disostose Craniofacial/terapia , Osteogênese por Distração/instrumentação , Cefalometria , Cirurgia Bucal/métodos , Ortodontia CorretivaRESUMO
PURPOSE: To analyze the microscopic characteristics of the effect of Gallium-Aluminum Arsenid diode laser (GaAlAs - 830etam) applied during the activation and consolidation period to ovine mandibles submitted to distraction osteogenesis. METHODS: Eighteen sheep underwent surgery in order to have bone distractors implanted in the left side of the jaw area. They were divided into three groups: 1 - Control; 2 - Laser irradiation during the activation period; 3 - Laser irradiation during the fixation period. The irradiation was carried out in five sessions, on every other day, with 4,0J/cm² doses applied to four pre-established areas, totaling 16J per session. After four days of latency under post-operative care, ten days of distractor activation (at 1mm/day) and twenty-one days of fixation the animals were sacrificed and the devices removed for microscopic analysis. RESULTS: The groups that received laser irradiation (GaAlAs) presented a greater amount of mineralized bone trabeculae when compared to the Control Group. Despite that, cartilaginous tissues were also found in Group 2. CONCLUSION: The laser has been more favorable when used in the consolidation period, after bone elongation.
OBJETIVO: Avaliar as características microscópicas do efeito do laser diodo de Arsenieto de Gálio-Alumínio (AsGaAl - 830etam), aplicado no período de ativação e consolidação de mandíbulas de ovelhas submetidas a distração osteogênica. MÉTODOS: Dezoito ovinos foram submetidos a procedimento cirúrgico para colocação de distrator ósseo em região de mandíbula do lado esquerdo, sendo divididos em três grupos: 1 - Controle; 2 - Irradiação de laser no período de ativação; 3 - Irradiação de laser no período de contenção. As irradiações foram feitas em cinco seções em dias alternados, com doses de 4,0J/cm² em quatro pontos pré-determinados, somando 16J por seção. Após quatro dias de latência no pós-operatório, 10 dias de ativação do distrator (1 mm/dia) e 21 dias de contenção os animais foram mortos e as peças removidas para análise microscópica. RESULTADOS: Os resultados foram que os grupos irradiados com laser (AsGaAl) apresentaram maior disposição de trabéculas ósseas mineralizadas em relação ao grupo controle, contudo, no Grupo 2 foi observada a presença de tecido cartilaginoso. CONCLUSÃO: O laser atuou de forma mais favorável quando utilizado no período de consolidação, após o alongamento ósseo.
Assuntos
Animais , Feminino , Calcificação Fisiológica/efeitos da radiação , Lasers Semicondutores/uso terapêutico , Mandíbula/cirurgia , Osteogênese por Distração , Matriz Óssea , Regeneração Óssea/efeitos da radiação , Calcificação Fisiológica/fisiologia , Modelos Animais de Doenças , Mandíbula/efeitos da radiação , Mandíbula/ultraestrutura , Osteogênese por Distração/instrumentação , Cuidados Pós-Operatórios , Ovinos , Fatores de Tempo , Cicatrização/efeitos da radiaçãoRESUMO
O tratamentodas deformidades craniofaciais foi revolucionado com o advento da técnica do alongamento ósseo gradual denominada distração osteogênica. Oito pacientes com diagnóstico de craniofaciossinostose foram submetidos a avanço fronto facial em monobloco com distração osteogência. Os pacientes foram divididos em 2 grupos de 4 pacientes. No grupo 1 (n=4), o avanço fronto facial foi realizado utilizado os distratores externos fabricados na SOBRAPAR. A idade média do grupo 1 foi de 10,5 anos. O tempo de seguimento do grupo 1 foi de 11 anos. No grupo 2 (n=4), o avanço fronto facial foi realizado utilizando os distratores internos fabricados nos USA pela KLS Martin - USA. A idade média do grupo 2 foi de 8,7 anos. O tempo de seguimento do grupo 2 foi de 1,5 anos. Traçados cefalométricos utilizando o padrão Ricketts foram utilizados para comparação de resultados. O índice de avanço médio do grupo foi 18,3 mm. As variações cefalométricas do grupo 1 foram: SNA: 7º, SNB: -3º. O índice de avanço médio do grupo 2 foi 10,7 mm. As variações cefalométricas do grupo 2 foram: SNA: 8.1º, SNB: -3,4º. Em ambos os grupos, os pacientes ficaram com enoftalmia temporária e com oclusão classe 2. No caso do grupo 1, a classe 2 envoluiu para classe 1 com o passar do tempo. No grupo 2, os pacientes permanecem em classe 2. Os pacientes dos 2 grupos tiveram boa evolução. A retrusão do terço médio, o exorbitismo, bem como o déficit respirat´roio foi tratado satisfatoriamente em ambos os grupos. Maior avanço ósseo do terço médio foi necessário no grupo 1, provavelmente decorrente de uma menor estabilidade óssea durante o processo de alongamento ósseo gradual.
Assuntos
Humanos , Criança , Acrocefalossindactilia , Alongamento Ósseo , Anormalidades Craniofaciais , Craniossinostoses , Osteogênese por Distração/instrumentaçãoRESUMO
Braquimetacarpiano o braquidactilia tipo E es el acortamiento anómalo de un metacarpiano o de un dedo. Esta anomalía corresponden al 5.2 por ciento de todas las malformaciones de la mano, siendo los metacarpianos 3º, 4º y 5º los más frecuentemente afectados (1-3). El problema se diagnóstica durante el crecimiento cuando se hace evidente un dedo más corto y/o el hundimiento del nudillo al cerrar el puño. Los procedimientos de elongación de metacarpianos actualmente más utilizados son: la distracción aguda y la colocación de injerto óseo. En esta revisión se muestra el caso clínico de una paciente tratada mediante la utilización de un tutor monoplanar externo, técnica relativamente nueva. En este caso se logró un alargamiento de 18 milímetros en un período de 4 meses, con excelentes resultados estéticos y funcionales.