Distraction Osteogenesis

Distraction Osteogenesis

Distraction Osteogenesis is a technique for growing new bone by slowly stretching the bone callus. It can be performed on both children and adults to replace bone grafting procedures. Commonly used in orthopedics to lengthen legs, arms, and fingers, these same principles have been applied to use in the human face.

The bone is surgically fractured and a callus (early, reparative soft bone) is allowed to form during the first 7 days. Then the distraction is begun at a rate of 1-2 mm per day up to a determined length (20 days for 20mm, or 5/8”). At this point, the body grows more bone callus as the bone ends are moved apart. This is the second phase called the activation period, and the rate of distraction is important to the final quality and quantity of bone formed. Finally, the bone segments are held in the position until the bone callus becomes solid.

This procedure can be applied to the skull, mid-face, cheekbones, orbits (eye sockets), and the mandible (lower jaw). Most of the time large movements are made to grow bone in these areas to avoid using bone grafts. A recent trend is to apply the technique in the place of more routine jaw surgery, because the bone-generating technique helps maintain more normal bone contour.

The operation to lengthen the jaw or move the mid-face takes 1-2 hours. It is performed under a general anesthetic and requires less than 24 hours of hospitalization. After the initial week, the patient or parent is taught how to activate the device. Record keeping and periodic x-rays aid in determining progress. The overall recovery and possible complications are similar to that of Orthognathic Jaw Surgery. (See the section on Orthognathic Surgery for details.) In some cases, orthodontics and/or additional surgery may be necessary in the future, depending on the growth and development of the patient.

Preparing For Surgery

At least 1 month prior to surgery
Stop smoking at least 1 month prior to your procedure. Smoking reduces circulation to the skin, impedes healing, and can lead to major postoperative complications.

Donate blood, as directed by your surgeons.  This process usually begins 1 month prior to surgery to allow time for the body to replenish its blood cells.

Begin taking a daily multi-vitamin with iron, as directed by your surgeon.

Arrange the necessary time off from work or school.  Most patients will need 1 to 2 weeks of convalescence.

2 weeks prior to surgery
Stop all medications that can thin the blood 2 weeks prior to surgery. These include drugs such as Aspirin, Coumadin, Lovenox, Ibuprofen, Vitamin E, and multiple herbal preparations. These medications may cause bleeding during and after surgery. Please see the warning about blood thinning medications on our website for a list of drugs that must be stopped.

Begin taking 1,000 mg of vitamin C daily, in four 250 mg doses, as directed by your surgeon.

Obtain a blender and food processor to help with the post-operative diet.

Arrange for both a suction unit and a humidifier, which will help keep the nasal passages moist after surgery.

1 week prior to surgery
Report any sign of a cold or infection that appear the week prior to your surgery. You may need to postpone your procedure to avoid unnecessary complications. Make sure you fill all of your prescriptions provided to you by our doctors prior to your surgery day; this will make the transition from the surgery center to your home as smooth as possible.

The day before surgery
Do not eat or drink anything after midnight before your surgery. This includes water, ice, or hard candy. The only exception is that you may take your blood pressure or heart medication with a sip of water the morning of surgery.

Day of surgery

Plan to wear loose fitting clothes to the procedure.

Do not wear jewelry or bring valuables with you on the day of surgery.

Bring a writing tablet to help you communicate after surgery.

You may wash your surgical site with regular soap the day before and morning of surgery.

You must arrange to have a responsible adult drive you home after your procedure.

Pre-operative Instructions:

1. Plan to wear loose fitting clothes to the procedure.

2. Do not wear jewelry or bring valuables with you on the day of surgery.

3. Bring a writing tablet to help you communicate after surgery.

4. You may wash your surgical site with regular soap the day before and morning of surgery.

5. You must arrange to have a responsible adult drive you home after your procedure.

Post-operative Instructions

1. Keep head elevated on 2 pillows for 2 weeks.  This position aids in decreasing facial swelling and helps with bleeding.
2. Diet:  Do not chew anything; your diet should be fluids only.  For the first several days, use a syringe that injects the fluid in your mouth.  Take medications by syringe also.  You may advance the diet as you choose, remembering to protect the operative areas.  Adequate nutrition and maintaining body weight is important for recovery.  Plan to eat small “meals” at least 6 times per day.  Allow extra time at first.
3. Apply Vaseline to the lips, as needed.
4. Brush the teeth gently the first week with a soft toothbrush and your choice of toothpaste.  Do not brush the gums until the second week.  Always protect the incision sites until they are healed.
5. Use a decongestant nasal spray to dry up the oozing and open the nasal passages.  Use this decongestant only for 3 days.  Otherwise, rebound swelling may occur in the nasal tissues, making breathing more difficult.
6. Use a saltwater nasal spray, such as Ocean Spray, to break up any blood or mucous clots in the nose.  This infusion can be done over the sink as often and in whatever amounts as desired. 
7. Use a humidifier at night, aiming the vaporized water gently across the face to help keep the nasal passages moist.
8. Apply ice to the face for the first 24-36 hours to decrease the amount of swelling.  After this time, it may be continued as a comfort measure, but is no longer necessary.  Heat may be applied after 36 hours if it is comforting.
9. Do not use mouth washes containing alcohol, unless they are diluted in a 1:3 ratio with water, because the alcohol will irritate the incisions.
10. Rinse with warm salt water, either by cup or with the feeding syringe, beginning the day after surgery, and continue for 7 days.  (Dilution:  ½ teaspoon of salt in 1 cup of lukewarm water)
11. You may shower or bathe the day after surgery.  Make sure that you can sit in the shower or have someone with you to steady you.  After surgery, it is not uncommon to feel light-headed upon standing, especially while taking a warm shower. You may use regular soap and shampoo, even if there was a bone graft taken from the scalp or hip.  If a hip or cranial bone graft was taken, then a shower is preferred so the donor site (site of bone removal) is not soaking in bath water.  Cleaning after surgery will lift your spirits.
12. Do not lift anything over 10 pounds for 2 weeks.  Contact sports should be avoided for at least 8 weeks.  Make sure to ask you surgeon any other questions you might have regarding activity.
13. Avoid sun exposure and use a sunblock with at least a 20 SPF, since darkening of any incision on the skin can occur for up to six months. 
14. If your teeth are held together with wires, keep wire cutters with you at all times.
15. Call your surgeon with any questions or if you experience any of the following: temperature is over 101.0F, excessive bleeding or rapid swelling occurs, pain is unrelieved by prescribed pain medications, breathing is difficult, or you experience a sudden shift of the bite or bones.
16. Take one daily multiple vitamin with Iron and 1,000 mg of Vitamin C, in four 250 mg doses, for 6 weeks following surgery.
17. The External Activation Pin should be cleaned with a diluted solution of half water, half hydrogen peroxide.  Keep a log of this activation as directed by your surgeon.
18. The External Activation Pin should be covered with gauze and tape or a band-aid to keep clean and bacteria-free.   

All Surgery Carries Some Uncertainty & Risk

All surgical procedures involve some possible risks, such as the effects of anesthesia, infection, swelling, redness, bleeding, and pain. There are also potential complications specific to Distraction Osteogenesis. These complications occur in a very small percent of patients, but you need to be aware of the possible risks. After reading the discussion below, please contact your surgeon if you have questions.

Most of these are rare, but you should be aware that surgery can be unpredictable.  The possible complications include: Nerve injury (permanent numbness of the lip, tongue, cheek, etc.), relapse or return to original jaw positioning, damage to teeth, scarring, Temporomandibular (TMJ, or jaw joint) problems, nasal airway obstructions, non-union (inadequate closure) of the bone, or sinusitis (swelling of the nasal sinuses).