Long-term stability after craniofacial distraction osteogenesis

Bone Volume Analysis and Associated Influencing Factors in Mandibular Distraction Osteogenesis: A Retrospective Analysis

BACKGROUND

Distraction osteogenesis is a progressively popular technique for maxillofacial bone reconstruction, but there is a notable gap in the analysis of bone volume within the distraction segment and the exploration of associated influencing factors.

PURPOSE

The purpose of this study was to quantitatively analyze the new bone volume and the distraction gap volume in the three-dimensional (3D) model and explore the influencing factors associated with the percentage of the new bone volume to the distraction gap volume.

STUDY DESIGN, SETTING, SAMPLE

This retrospective study included patients who underwent maxillofacial distraction osteogenesis treatment at the West China Hospital of Stomatology between 2014 and 2022, utilizing the mandibular distractor (Cebei, Ningbo, China). Exclusion criteria encompassed individuals with incomplete clinical or radiographical records as well as those who loss to follow-up.

PREDICTOR VARIABLE

The predictor variables were age, sex, diagnosis, consolidation period duration, distraction modality, osteotomy area, distraction gap volume, and proximal bone segment volume.

MAIN OUTCOME VARIABLE(S)

The outcome variable was osteogenic effect which defined as the percentage of the new bone volume to the distraction gap volume in the 3D model.

COVARIATES

Not applicable.

ANALYSES

T-tests were used to describe categorical variables, and Pearson correlation analysis was used to describe continuous variables. Linear regression was employed to assess the predictiveness of variables for osteogenic effect. Data are described as mean ± standard deviation; statistical significance was established at a P value < .05.

RESULTS

The study sample contained 35 patients(11 males and 24 females) with a mean age of 21.17 ± 11.82 years (range: 5 to 47 years) were included. The mean osteogenic effect of all samples was 78.89 ± 24.70%. Multiple linear regression models confirmed that the osteogenic effect was significantly influenced by the distraction gap volume (P = .003), proximal bone segment volume (P = .009), osteotomy area (P = .034), diagnosis (P = .004), and distraction modality (P = .021).

CONCLUSION AND RELEVANCE

The percentage of new bone mass to simulated volume based on 3D model measurement can serve as an effective quantitative indicator for evaluating the osteogenic effect; our study demonstrates that distraction gap volume, proximal bone segment volume, osteotomy area, diagnosis, and distraction modality can statistically significantly influence the osteogenic effect.

Treatment of severe micrognathia in an adult with distraction osteogenesis: A case report

Key Clinical Message

Distraction osteogenesis (DO) of the mandible is often performed at a young age, and there are few reports after age 30, as in this case. The Hybrid MMF used in this case was useful in that it allowed correction of fine directionality.

Abstract

DO is often performed in young patients with a high capability of osteogenesis. We performed distraction surgery for a 35-year-old man who had severe micrognathia with serious sleep apnea syndrome. Four years postoperatively, suitable occlusion and improvement of apnea were observed.

Distraction Osteogenesis Versus Orthognathic Surgery: Demystifying Differences in Concepts, Techniques and Outcomes

Introduction

The popularity and interest evoked by orthognathic surgery and distraction osteogenesis are undisputed in the field of oral and maxillofacial surgery. However, questions regarding the individual identities of either of them with clarity in their concepts, techniques and outcomes have remained unanswered. The aim of this review is to shed light on these questions.

Methods

This review is structured as a narrative review of thirty years of literature available in the specialities of orthognathic surgery and distraction osteogenesis.

Conclusion

The authors present a review of existing literature combined with contrasting experience gained over the years in providing an overview of the merits and demerits of the two surgical techniques which will aid the clinician in justifying the use of one technique over the other.

Is Distraction Osteogenesis of the Irradiated Craniofacial Skeleton Contraindicated?

BACKGROUND

Craniofacial distraction osteogenesis (DO) is a common treatment modality today. Despite its numerous advantages, however, concerns have been expressed regarding the use of DO in the irradiated setting.

METHODS

A systematic review was performed to identify all published reports of patients who underwent DO of the irradiated craniofacial skeleton. The following parameters were of particular interest: postoperative complications, specifically, insufficient bone formation, fracture, and hardware exposure (intraoral and cutaneous), as well as the need for additional bone grafting.

RESULTS

The initial search retrieved a total of 183 articles of which 20 articles (38 patients) met predetermined inclusion criteria. The most common site of distraction was the mandible (76.3%). The median radiation dose was 50.7 Gy (range, 30-70 Gy). Bone defects ranged from 30 to 80 mm (median, 42.5 mm). Complications were encountered in 19 patients (50%), with insufficient bone formation being most common (9 patients; 23%). The overall incidence of complications was not significantly associated with radiation dosage (P = 0.79). The remaining procedural and demographic variables also failed to meet statistical significance when compared against the overall complication rate (P = 0.27-0.97).

CONCLUSION

The complication rate associated with craniofacial DO of the irradiated skeleton does not appear to be substantially higher than what is reported for DO in the nonirradiated setting. As such, patients should be offered this treatment modality, particularly in light of the fact, that it offers the option to decrease patient morbidity as well as treatment complexity.

Clinical Use of Deferoxamine in Distraction Osteogenesis of Irradiated Bone

The deleterious effects of radiotherapy, including hypovascularity and hypocellularity, have made distraction of irradiated bones challenging. Animal studies, however, have demonstrated adjunctive measures such as the administration of deferoxamine to significantly improve bone regeneration across irradiated distraction gaps. In this report, the authors demonstrate, for the first time, enhanced bone formation following deferoxamine application in a patient following distraction of a previously irradiated maxilla. Computed tomography imaging of the pterygomaxillary buttress on the side of administration revealed significantly increased bone area and density relative to the contralateral buttress. This is the first presentation of clinical deferoxamine use to promote bone formation following irradiated bone distraction and highlights the promise for this adjunctive measure to make outcomes after distraction of irradiated bone more reliable.

Long-Term Maxillomandibular Changes after Maxillary Distraction Osteogenesis in Growing Children with Cleft Lip with or without Palate

Objective

To evaluate the long-term maxillomandibular changes after maxillary distraction osteogenesis in growing children having cleft lip with or without cleft palate.

Patients

Eight Japanese patients with cleft lip with or without cleft palate aged 9.3 to 13.1 years.

Measures

The maxillary and mandibular positions before (TO), immediately after (T1), and 1, 3, and 5 years after distraction osteogenesis (T2, T3, and T4, respectively) measured on cephalograms superimposed at the sella turcica with the Frankfort horizontal plane as the horizontal reference. The anterior nasal spine (x, y), pogonion (x), and menton (y) were used for linear measurements, and sella turcica-nasion-point A, sella turcica-nasion-point B, and point A-nasion-point B angles were used for angular measurements.

Results

The mean horizontal maxillary advancement (anterior nasal spine [x]) was 12.3 mm during TO to T1, but -2.7, -1.1, and -0.1 mm of the posttreatment changes were observed during T1 to T2, T2 to T3, and T3 to T4, respectively. Anterior nasal spine (y) shifted 2.3 mm downward during TO to T1, and further downward changes were observed during T1 to T2 and T2 to T3 ( P < .05). Pogonion (x) did not show distinct changes due to individual variance, but menton (y) shifted downward from T1 to T4. Sella turcica-nasion-point A significantly decreased during T1 to T2 and T2 to T3 but not during T3–T4. Point A-nasion-point B significantly decreased only during T2 to T3, and sella turcica-nasion-point B did not show any distinct change.

Conclusions

There was no further maxillary advancement after distraction osteogenesis in the growing children with cleft lip with or without cleft palate. Therefore, long-term observation and management of occlusion in case of the mandibular growth pattern are important.

Cephalometric evaluation of airways after maxillary anterior advancement by distraction osteogenesis in cleft lip and palate patients: a systematic review

OBJECTIVE

This study was conducted to review the changes in airways after maxillary anterior advancement by distraction osteogenesis in patients with cleft lip and palate.

MATERIALS AND METHODS

Several electronic databases were searched. The selection criteria were set to include clinical trials and at least 1 year of postsurgical data. The original articles were then retrieved and evaluated by two investigators to ensure that they met the selection criteria. The references were also hand searched for possible missing articles.

RESULTS

Forty-three abstracts were found in the electronic searches. After the first set of selection criteria was applied to these abstracts, 14 articles were retrieved. After the final selection criteria, only four articles were finally selected. However, sample sizes of the selected articles were small, and the methodological quality of the studies was inadequate. All selected articles were consistent in that upper airway sizes increased and nasal resistance was reduced after distraction osteogenesis.

CONCLUSIONS

Despite the consistency of increasing the upper airway size and reducing nasal resistance in the only four found articles, limitations of the studies merit caution in interpreting these findings. We conclude that there are insufficient prospective randomized controlled clinical trials to confirm these results.

Regenerate healing outcomes in unilateral mandibular distraction osteogenesis using quantitative histomorphometry

BACKGROUND

The authors' goal was to ascertain regenerate bone-healing metrics using quantitative histomorphometry at a single consolidation period.

METHODS

Rats underwent either mandibular distraction osteogenesis (n = 7) or partially reduced fractures (n = 7); their contralateral mandibles were used as controls (n = 11). External fixators were secured and unilateral osteotomies performed, followed by either mandibular distraction osteogenesis (4 days' latency, then 0.3 mm every 12 hours for 8 days; 5.1 mm) or partially reduced fractures (fixed immediately postoperatively; 2.1 mm); both groups underwent 4 weeks of consolidation. After tissue processing, bone volume/tissue volume ratio, osteoid volume/tissue volume ratio, and osteocyte count per high-power field were analyzed by means of quantitative histomorphometry.

RESULTS

Contralateral mandibles had statistically greater bone volume/tissue volume ratio and osteocyte count per high-power field compared with both mandibular distraction osteogenesis and partially reduced fractures by almost 50 percent, whereas osteoid volume/tissue volume ratio was statistically greater in both mandibular distraction osteogenesis specimens and partially reduced fractures compared with contralateral mandibles. No statistical difference in bone volume/tissue volume ratio, osteoid volume/tissue volume ratio, or osteocyte count per high-power field was found between mandibular distraction osteogenesis specimens and partially reduced fractures.

CONCLUSIONS

The authors' findings demonstrate significantly decreased bone quantity and maturity in mandibular distraction osteogenesis specimens and partially reduced fractures compared with contralateral mandibles using the clinically analogous protocols. If these results are extrapolated clinically, treatment strategies may require modification to ensure reliable, predictable, and improved outcomes.

Dental team management for a patient with Klippel-Feil syndrome: case report

Klippel-Feil syndrome (KFS) is a rare congenital abnormality characterized by a short neck, a low posterior hairline, and limited head movement. Occasionally, patients with KFS may also show signs of deafness, intellectual disability, cardiac malformation, palpebral ptosis, facial nerve paralysis, cleft palate, and scoliosis. Although some researchers have documented this syndrome, scant attention has been paid to craniomaxillofacial manifestations and dental treatment of patients with KFS. The objective of this case report was to describe the planning and execution of dental treatment for a 10-year-old male patient with KFS.