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; the 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 seven 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 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.
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