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Kim TH, Kim YC, Rah YS, Choi JW. Hemi one-piece distraction osteogenesis for unilateral coronal craniosynostosis. J Craniomaxillofac Surg 2024; 52:252-259. [PMID: 38169232 DOI: 10.1016/j.jcms.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 09/15/2023] [Accepted: 12/22/2023] [Indexed: 01/05/2024] Open
Abstract
INTRODUCTION It was the aim of the study to assess the efficacy of the hemi one-piece distraction osteogenesis and to compare it to the traditional one-piece distraction osteogenesis technique. METHODS Two different surgical techniques were used; the one-piece distraction and the hemi one-piece distraction. The principal distinction between the two techniques is that in the hemi style approach, the intact sutures on the contralateral side were left undisturbed, with no osteotomy performed. RESULTS The hemi one-piece group had a significantly lower median value of plastic surgery time, total operation time, and transfusion rate (plastic surgery time 69 min (range 65-120) vs. 20 min (range 17-32.5), p < 0.001; transfusion 80 mL (range 0-150) vs. 0 mL (0-60), p = 0.1. Nasofrontal advancement was successful with no major complications. Median endocranial angulation improved (one-piece: 166.1°-176.0°, hemi: 162.9°-173.0°, p = 0.023 & p = 0.012 respectively). CONCLUSION This study reveals less invasive, highly effective techniques for craniosynostosis treatment, notably a unilateral osteotomy with distraction method. Nevertheless, to confirm their long-term efficacy and durability, more studies with longer follow-ups are essential.
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Affiliation(s)
- Tae Hyung Kim
- Department of Plastic and Reconstructive Surgery, Seoul Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Young Chul Kim
- Department of Plastic and Reconstructive Surgery, Seoul Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Young Shin Rah
- Department of Neurosurgery, Seoul Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea
| | - Jong Woo Choi
- Department of Plastic and Reconstructive Surgery, Seoul Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
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Influence of Bone-Borne Trans-Sutural Distraction Osteogenesis Therapy on the Hard Palate of Growing Children With Cleft Lip and Palate. J Craniofac Surg 2022; 33:390-394. [DOI: 10.1097/scs.0000000000008043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Bone transport using the Ilizarov method for osteosarcoma patients with tumor resection and neoadjuvant chemotherapy. J Bone Oncol 2019; 16:100224. [PMID: 30989037 PMCID: PMC6447741 DOI: 10.1016/j.jbo.2019.100224] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 02/09/2019] [Accepted: 02/11/2019] [Indexed: 12/13/2022] Open
Abstract
Background Studies on the applications of bone transport using the Ilizarov method for osteosarcoma (OS) patients with surgical resection and neoadjuvant chemotherapy are rare. Methods A retrospective analysis was conducted in 10 patients with limb OS receiving limb-salvage treatment by Ilizarov method from 2007 to 2012 in our hospital. The general information, treatment outcomes and follow-up data of the patients were collected. Results The mean length of the transported fragment and the mean transport distance of the affected limb were both 14 cm. The mean time in the external fixator was 34.2 ± 11.2 months (16-47 months) and the mean external fixation index (EFI) was 75 days/cm. The mean follow-up time was 68.6 ± 26.6 months (37-103 months). Seven patients underwent additional operations to treat the postoperative complications, and the mean number of operation was 1.7 times. Only one patient underwent amputation due to tumor relapse and all patients survived without tumor. The limb-salvage rate was 90%. At the time of external fixator removal, the ASAMI-bone score was good in 66.7% of patients and the ASAMI-function score was fair in 66.7% of cases. The mean MSTS score was 18.6 ± 3.2 (n = 9). At 10 months after fixator removal, both the ASAMI-bone score and ASAMI-function score were both excellent in 80% and good in 20% cases, and the mean MSTS score was further improved to 27.2 ± 1.11 (n = 5). Conclusion Bone transport using the Ilizarov method can achieve good therapeutic effectiveness in the limb-salvage treatment for OS patients with neoadjuvant chemotherapy as long as the complications can be timely recognized and well managed.
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Guiran Z, Ying W, Guijun W, Chengyue W, Yusheng Y. A New Way to Accelerate the Distraction of the Transpalatal Suture in Growing Dogs Using Recombinant Human Bone Morphogenetic Protein-2. Cleft Palate Craniofac J 2015; 54:193-201. [PMID: 26523326 DOI: 10.1597/15-044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the administration of recombinant human bone morphogenetic protein-2 (rhBMP-2) on trans-sutural distraction osteogenesis (TSDO) of the transverse palatal suture in growing dogs. STUDY DESIGN A total of 36 growing dogs were used in this study. The experimental animals were treated with different elastic force and rhBMP-2. The bone regeneration was determined with X-ray, histology, and clinical evaluation. The computed values underwent statistical analyses using analysis of variance. RESULTS The maxillary complex was most noticeably advanced with an applied elastic force of 600 g (22.4 ± 5.0 mm) and 800 g + rhBMP-2 (24 ± 5.1 mm). Immunohistochemical staining showed that the expression of bone morphogenetic protein-2 and bone morphogenetic protein-4 varied with different elastic force. These changes were statistically significant when 600 g and 800 g + rhBMP-2 were applied within 2 weeks of distraction when compared with controls (P < .05). CONCLUSIONS The results of this study suggest that TSDO in the growing dog should be safe and well tolerated when inducing bony lengthening of the maxilla. rhBMP-2 plays an important role in bone regeneration using TSDO.
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Yusheng Y, Chengyue W, Zhiying W, Guijun W. Transsutural distraction and tissue regeneration of the midfacial skeleton: experimental studies in growing dogs. Cleft Palate Craniofac J 2013; 51:326-33. [PMID: 23369015 DOI: 10.1597/12-056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective : The purpose of this study was to evaluate the effect of different mechanical forces on the expansion of the palatine suture using transsutural distraction osteogenesis. Methods : A total of 48 dogs were used in this study. The experimental groups were treated with a custom-designed internal distractor. Bone regeneration was determined with x-rays and histology. The computed values underwent statistical analyses using analysis of variance. Results : The maxillary complex was most noticeably advanced with an applied mechanical force of 600 g (20.15 ± 1.36 mm), compared with forces of 400 g (19.88 ± 1.41 mm) and 800 g (2.24 ± 0.93 mm). Immunohistochemical staining showed that the expression of bone morphogenetic protein-2 and bone morphogenetic protein-4 fluctuated with different mechanical forces. These changes were statistically significant when 600 g of force was applied within 30 days of distraction (P < .05). Conclusions : Transsutural distraction osteogenesis in the growing dog should be safe and well tolerated in inducing bony lengthening of the maxilla, and the optimal force is 600 × g. Bone morphogenetic protein-2 and bone morphogenetic protein-4 may play an important roles in the signaling pathways that link mechanical forces and biological responses.
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Synergistic Enhancement of New Bone Formation by Recombinant Human Bone Morphogenetic Protein-2 and Osteoprotegerin in Trans-Sutural Distraction Osteogenesis: A Pilot Study in Dogs. J Oral Maxillofac Surg 2011; 69:e446-55. [DOI: 10.1016/j.joms.2011.07.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Revised: 06/07/2011] [Accepted: 07/13/2011] [Indexed: 01/04/2023]
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Liang L, Liu C. Trans-sutural distraction osteogenesis for alveolar cleft repair: an experimental canine study. Cleft Palate Craniofac J 2011; 49:701-7. [PMID: 21806476 DOI: 10.1597/10-250] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To explore a new method of repair of alveolar cleft by trans-sutural distraction osteogenesis. DESIGN Nine 8-week-old mongrel dogs were assigned randomly to two groups with three in the control group and six in the experimental group. SETTING First, an alveolar cleft model was created surgically in all animals. After 2 weeks, a U-shaped distractor, made of nickel-titanium (NiTi) shape memory alloy wire with 200 g tensile force, was inserted into the premaxilla of the experimental dogs to distract the mid-premaxillary suture for 3 weeks. Periosteoplasty of the alveolar cleft was performed when the premaxilla at the side of cleft approached the maxilla at the same side. The distractor was removed 2 weeks post periosteoplasty. OUTCOME MEASURES The results were evaluated clinically, radiographically, and morphologically. RESULTS The cleft model was stable and similar to the human alveolar cleft. No spontaneous bone union occurred in the control. In experimental dogs, the premaxilla was moved slowly toward the maxilla, and the cleft became gradually narrower and closed in the third week. Radiographically, the distracted mid-premaxillary suture showed a gradually widened triangle, with the tip of the triangle pointed posteriorly. The density of the distracted triangle suture was increased gradually. The alveolar cleft was completely bony 3 months post periosteoplasty. The morphology of the mid-premaxillary suture was also restored. CONCLUSION The alveolar cleft could be repaired by the technique of mid-premaxillary suture distraction using the elastic device of NiTi shape memory alloy.
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Affiliation(s)
- Limin Liang
- Department of Oral and Maxillofacial Surgery, the General Hospital and Postgraduate Medical College of Chinese P.L.A., Beijing, China
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The biomechanical characteristics of cranial sutures are altered by spring cranioplasty forces. Plast Reconstr Surg 2010; 125:1111-1118. [PMID: 20335863 DOI: 10.1097/prs.0b013e3181d0abcf] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The mechanical properties of the pediatric craniofacial complex allow dissipation of spring cranioplasty forces. Springs do not fully expand in situ and continue to transmit a continuous force until removal. The authors wished to investigate whether ongoing forces altered the biomechanical characteristics of cranial sutures. METHODS Thirty New Zealand White rabbits were divided into five groups: spring expansion for 4, 7, and 10 weeks; early spring removal at 4 weeks followed by monitoring for 3 weeks; and a control group (n = 6 each). Cranial expansion was monitored using cephalometry. The left coronal suture then underwent load-displacement testing in a dynamometer. RESULTS Relapse of cranial expansion was observed following early spring removal (mean, 6 percent; p = 0.017). Cranial suture thickness was significantly correlated to the length of spring insertion. Load displacement curves of sutures in all groups initially exhibited classic viscoelastic behavior. The treatment group developed intrasutural weakening before failure that was not observed in controls. The peak load before failure as a percentage of that observed in controls was 31 percent in the 4-week group (p = 0.001), 35 percent in the 7-week group (p = 0.000), and 45 percent in the 10-week group (p = 0.023). CONCLUSIONS Cranial suture compliance is modified in the presence of continuous spring cranioplasty forces. Thickening of the coronal sutures, which have been expanded in a shear-like manner, increases their three-dimensional surface area and may contribute to the relative lack of relapse observed after early spring removal.
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Coronal Suturectomy Through Minimal Incisions and Distraction Osteogenesis Are Enough Without Other Craniotomies for the Treatment of Plagiocephaly Due to Coronal Synostosis. J Craniofac Surg 2009; 20:1975-7. [DOI: 10.1097/scs.0b013e3181bd2cd6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Correction of nonsynostotic scaphocephaly without cranial osteotomy: spring expansion of the sagittal suture. Childs Nerv Syst 2009; 25:225-30. [PMID: 18839187 DOI: 10.1007/s00381-008-0719-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Scaphocephaly is usually due to sagittal synostosis. Scaphocephaly may also be seen in the presence of a nonsynostosed sagittal suture. In this situation traditional surgery is controversial due to the altered risk-benefit profile. This paper reports the first known series of patients with nonsynostotic scaphocephaly treated using spring assisted expansion of the sagittal suture. METHODS All patients referred to our craniofacial program over the period February 2005-February 2008 were retrospectively reviewed. Eleven patients were seen with nonsynostotic scaphocephaly. Seven patients underwent spring expansion of the sagittal suture without osteotomy. RESULTS Four female and three male patients had spring expansion of a patent sagittal suture. Four patients were born prematurely. Two patients had Beckwith-Weidemann syndrome. The ages ranged from 6 to 26 months (mean 12 months). The average preoperative cranial index was 66 (range 63-67). This improved to 76 at the time of spring removal (range 73-78). Springs were kept in situ for an average of 7.25 months. The mean blood loss was 7 ml and the mean operative time 36 min. CONCLUSION Spring cranioplasty for sagittal synostosis is ideally performed before 6 months of age however in nonsynostotic scaphocephaly older children can be considered due to the absence of frontal bossing. Significant aesthetic improvement was achieved in all cases and normalization of the cranial index was achieved in 86% of cases with minimal morbidity and no significant complications. This technique is an alternative for nonsynostotic cases that were previously either untreated or undergone major remodelling surgery.
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Al-Daghreer S, Flores-Mir C, El-Bialy T. Long-term stability after craniofacial distraction osteogenesis. J Oral Maxillofac Surg 2008; 66:1812-9. [PMID: 18718387 DOI: 10.1016/j.joms.2007.08.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2007] [Accepted: 08/26/2007] [Indexed: 10/21/2022]
Abstract
PURPOSE This study was conducted to systematically review long-term skeletal stability after craniofacial distraction osteogenesis. MATERIALS AND METHODS Several electronic databases (Old Medline, Medline, Medline In-Process and Other Non-Indexed Citations, Pubmed, Embase, Web of Science, and all EBM reviews [Cochrane Database of Systematic Reviews, ACP Journal Club, DARE, and CCTR]) were searched. Key words used in the search were "distraction," "osteogenesis," "craniofacial," "maxillofacial," "stability," "relapse," and "recurrence." MeSH terms and truncations of these terms were selected with the help of a health science librarian. Abstracts that appeared to contain at least 3 years of postsurgical data were selected. The original articles were then retrieved and evaluated to ensure that they actually had 3 years of data after craniofacial distraction osteogenesis. The references were also hand-searched for possible missing articles that were not indexed in the searched databases. RESULTS A total of 118 abstracts were found in the electronic searches. After the first set of selection criteria was applied on these abstracts, 22 articles were retrieved. After the final selection criteria were applied on these 22 articles, only 6 articles were finally selected. These 6 articles reported long-term stability after craniofacial distraction osteogenesis. Sample sizes were small, and the methodological quality of the studies was poor. CONCLUSIONS Although, based on the selected studies, craniofacial bone distraction osteogenesis appeared to show long-term stability; limitations of the studies merit caution in interpreting these findings. Some early relapse occurred in the first 3 years postdistraction, but stability was maintained thereafter. Some methodologically sounder studies are needed to confirm the present findings.
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Affiliation(s)
- Saleh Al-Daghreer
- Orthodontic Graduate Program, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Bilodeau JE. Nonsurgical treatment with rapid mandibular canine retraction via periodontal ligament distraction in an adult with a Class III malocclusion. Am J Orthod Dentofacial Orthop 2005; 128:388-96. [PMID: 16168338 DOI: 10.1016/j.ajodo.2004.05.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2004] [Revised: 05/18/2004] [Accepted: 05/18/2004] [Indexed: 11/26/2022]
Abstract
A woman with a Class III malocclusion was a poor candidate for orthognathic surgery. An orthodontic treatment plan was developed that incorporated a relatively new and rapid process of canine distraction. The mandibular first premolars were extracted, correcting the anterior crossbite, the Class III canine relationship, and the Class III facial appearance. The canines were distracted, through the periodontal ligament, into the extraction sites. Dental distraction is a breakthrough for orthodontics, especially for adults with critical anchorage requirements.
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Liou EJW, Tsai WC. A new protocol for maxillary protraction in cleft patients: repetitive weekly protocol of alternate rapid maxillary expansions and constrictions. Cleft Palate Craniofac J 2005; 42:121-7. [PMID: 15748102 DOI: 10.1597/03-107.1] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE It was hypothesized that, through a repetitive weekly protocol of Alternate Rapid Maxillary Expansions and Constrictions (Alt-RAMEC), the maxilla in cleft patients could be protracted more effectively than with a single course of rapid maxillary expansion (RME). METHODS Twenty-six consecutive unilateral cleft lip and palate patients at the age of mixed dentition were included in this prospective clinical study. The rapid maxillary expansion group included the first 16 consecutive patients undergoing 1 week of rapid maxillary expansion (1 mm/day) followed by 5 months, 3 weeks of maxillary protraction. The Alternate Rapid Maxillary Expansions and Constrictions group included the next 10 consecutive patients undergoing 9 weeks of Alternate Rapid Maxillary Expansions and Constrictions followed by 3 months, 3 weeks of maxillary protraction. Daily activation of the weekly expansion or constriction was 1.0 mm. Two-hinged expanders and intraoral maxillary protraction springs were used in both groups. Treatment results were evaluated cephalometrically. RESULTS The amount of maxillary anterior displacement by the 2-hinged expander in the Alternate Rapid Maxillary Expansions and Constrictions group was 3.0 +/- 0.9 mm at A point, significantly greater than the 1.6 +/- 1.0 mm in the rapid maxillary expansion group. The amount of maxillary advancement with intraoral protraction springs in the Alternate Rapid Maxillary Expansions and Constrictions group was 2.9 +/- 1.9 mm at A point, significantly greater than the 0.9 +/- 1.1 mm in the rapid maxillary expansion group. The overall amount of maxillary advancement in the Alternate Rapid Maxillary Expansions and Constrictions group was 5.8 +/- 2.3 mm at A point. This result remained stable, without significant relapse after 2 years. CONCLUSIONS Maxillary protraction using the 2-hinged expander, a repetitive weekly protocol of Alternate Rapid Maxillary Expansions and Constrictions, and intraoral protraction springs is most effective, with stable results at 2-year follow-up.
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Affiliation(s)
- Eric Jein-Wein Liou
- Department of Orthodontics and Craniofacial Dentistry, Chang Gung Memorial Hospital, Taipei, Taiwan.
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Henderson JH, Longaker MT, Carter DR. Sutural bone deposition rate and strain magnitude during cranial development. Bone 2004; 34:271-80. [PMID: 14962805 DOI: 10.1016/j.bone.2003.10.007] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2003] [Revised: 08/08/2003] [Accepted: 10/29/2003] [Indexed: 11/17/2022]
Abstract
It is widely believed that rapid growth of the human brain generates tensile strain in cranial sutures, and that this strain influences the rate of bone deposition at the sutural margins during development. We developed general theoretical techniques for estimating sutural bone deposition rate and strain magnitude during mammalian cranial development. A geometry-based analysis was developed to estimate sutural bone deposition rate. A quasi-static stress analysis was developed to estimate sutural strain magnitude. We applied these techniques to the special case of normal cranial development in humans. The results of the bone deposition rate analysis indicate that average human sutural bone deposition rate is on the order of 100 microm/day at 1 month of age and decreases in an approximately exponential fashion during the first 4 years of life. The results of the strain analysis indicate that sutural strain magnitude is highly dependent on the assumed stiffness of the sutures, with estimated strain at 1 month of age ranging from approximately 20 to 400 microstrain. Regardless of the assumed stiffness of the sutures, the results indicate that sutural strain magnitude is small and decreases in an approximately exponential fashion during the first 4 years of life. The finding that both sutural bone deposition rate and strain magnitude decrease with increasing age is consistent with quasi-static tensile strain in sutures influencing sutural osteoblast activity in a dose-dependent manner. However, the small magnitude of the predicted strains suggests that tissue level strains in sutures may be too small to directly influence osteoblast biology. In light of these results, we suggest other biomechanical mechanisms, such as a tension-induced angiogenic environment in the sutures or mechanotransduction in the underlying dura mater, through which tension across sutures may regulate the rate of bone deposition in sutures.
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Affiliation(s)
- James H Henderson
- Department of Surgery, Stanford University School of Medicine, Stanford University, Stanford, CA 94305, USA.
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Sasaki A, Sugiyama H, Tanaka E, Sugiyama M. Effects of sutural distraction osteogenesis applied to rat maxillary complex on craniofacial growth. J Oral Maxillofac Surg 2002; 60:667-75. [PMID: 12022106 DOI: 10.1053/joms.2002.33117] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE This study was designed to investigate the effects of artificial mechanical separation of the circummaxillary sutures on craniofacial growth in growing rats. MATERIALS AND METHODS Twenty 4-week-old Wistar strain male rats were divided equally into experimental and control groups. In the experimental group, 4 holes were made on the maxillary and temporary bones, and expansion appliances were placed into the holes for sutural separation bilaterally. The operated control group underwent sham surgery only. Lateral and dorsoventral cephalograms were taken of the animals every 2 weeks from age 4 to 12 weeks. Linear and angular measurements on the lateral cephalograms were analyzed and subjected to statistical treatment with Student's t-test. All animals were killed for histologic examination 8 weeks after the initiation of the experiment. RESULTS Nasomaxillary growth and the forward displacement were significantly larger in the experimental group than in the controls (P <.01). New bone formation was clearly observed in the (mechanically separated) sutural space in association with normal healing of the sutural structures. CONCLUSIONS These findings show that mechanical separation of the circummaxillary sutures, as a new orthopedic approach, accelerated nasomaxillary growth, in this experimental model.
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Affiliation(s)
- Akiko Sasaki
- Department of Orthodontics, Hiroshima University Faculty of Dentistry, Hiroshima, Japan.
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Swennen G, Dempf R, Schliephake H. Cranio-facial distraction osteogenesis: a review of the literature. Part II: Experimental studies. Int J Oral Maxillofac Surg 2002; 31:123-35. [PMID: 12102408 DOI: 10.1054/ijom.2002.0225] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In this study the literature dealing with experimental cranio-facial distraction osteogenesis (DO) was reviewed. A PUBMED search (National Library of Medicine [NCBI] revised 1 April 2001) from 1966 through December 2000 was conducted. Key words used in the search were: distraction, lengthening, mandible, mandibular, maxilla, maxillary, midface, midfacial, monobloc, cranial, cranio-facial, maxillofacial. This search revealed a total of 120 experiment-orientated articles that were all analyzed in detail in this study. The purpose of the experimental study, animal model, animal growth status, type of distraction, type of surgery, distraction rate and rhythm, latency and contention period, amount of lengthening, relapse, complications and nature of the distraction device were analyzed. This review revealed that a total of 1207 animals were used in seven different animal models for research on cranio-facial DO: 54 using dogs (45.0%), 25 using rabbits (20.8%), 18 using sheep (15.0%), 11 using minipig (9.2%), seven using monkeys (5.8%), four using rats (3.3%) and one using a cat model (0.8%). Based on the results of this study, an attempt was made to provide biological DO parameters and guidelines for future research on experimental cranio-facial DO related to the appropriate animal model.
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Affiliation(s)
- G Swennen
- Department of Oral and Maxillofacial Surgery, Medizinische Hochschule Hannover, Germany.
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Bouletreau PJ, Warren SM, Paccione MF, Spector JA, McCarthy JG, Longaker MT. Transport distraction osteogenesis: a new method to heal adult calvarial defects. Plast Reconstr Surg 2002; 109:1074-84. [PMID: 11884839 DOI: 10.1097/00006534-200203000-00046] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Popularized by Gavril Ilizarov in the 1960s, monofocal distraction osteogenesis has become a well-established method of endogenous bone engineering. This revolutionary surgical technique has significantly augmented the available reconstructive orthopedic and craniomaxillofacial procedures. Bifocal distraction osteogenesis, or bone transportation, is a modification of monofocal distraction that involves moving a free segment of living bone to fill an intercalary bone defect. Bifocal distraction has been applied successfully to reconstruct complex mandibular and long bone defects. Because traumatic or postsurgical calvarial defects do not spontaneously heal in humans older than 18 to 24 months of age, we hypothesized that bifocal distraction osteogenesis could be applied to the skull to close critical size calvarial defects. Critical size (15 x 15 mm) calvarial defects were created in eight New Zealand White rabbits. Next, a 15-mm x 10-mm calvarial box osteotomy was created just anterior to the skull defect. This osteotomy created a free bone segment that could be transported. A custom-made transport distraction device was fixed into place and the skin incision was closed. After a 4-day latency period, the distraction device was activated (0.5 mm once daily for 30 days) in seven animals; the distraction device in one animal was not activated and served as a control. All animals underwent 30 days of consolidation and were then killed. Radiographs and computed tomographic scans were performed at the following time points: end of latency period (postoperative day 4), mid-distraction (postoperative day 19), and end of consolidation period (postoperative day 64). Gross and histologic analysis was performed to evaluate the quality of the bony regenerate. The control animal healed with a fibrous union. Complete closure of the skull defects was observed in five of seven rabbits at the end of the consolidation period. One animal was removed from the study because of an early loosening of the distraction device, and one was removed because of device failure. Of the remaining five animals that completed the distraction protocol, radiographs and computerized tomographic scans showed successful ossification in all five rabbits at the end of the consolidation period. This study suggests that transport distraction osteogenesis is a promising technique that may be applied to a variety of commonly encountered craniofacial problems such as nonhealing calvarial defects.
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Affiliation(s)
- Pierre J Bouletreau
- Department of Surgery, New York University Medical Center, New York, NY, USA
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Hierl T, Klöppel R, Hemprich A. Midfacial distraction osteogenesis without major osteotomies: a report on the first clinical application. Plast Reconstr Surg 2001; 108:1667-72. [PMID: 11711944 DOI: 10.1097/00006534-200111000-00035] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- T Hierl
- Department of Oral and Maxillofacial Plastic Surgery, University of Leipzig, Germany.
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Liu C, Song R, Song Y. Sutural expansion osteogenesis for management of the bony-tissue defect in cleft palate repair: experimental studies in dogs. Plast Reconstr Surg 2000; 105:2012-25; discussion 2026-7. [PMID: 10839399 DOI: 10.1097/00006534-200005000-00016] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
A series of experimental studies on sutural expansion osteogenesis for management of the bony-tissue defect in cleft palate repair was performed between 1995 and 1997. Forty-five young dogs in weaning were used in four experiments that were divided into two parts. Part I probed the possibility of closing the surgically constructed hard palate cleft not only with mucoperiosteum but also with bony tissue by the technique of sutural expansion of lateral palatine sutures. Part II explored the possibility of pushing the palatine bone posteriorly and advancing the maxillary segment anteriorly by transverse palatine suture expansion. In Part I, a ring-shaped suture expander made of nickel-titanium shape memory alloy was used to expand the lateral suture of palatine bones. Expansion forces of 200 G, 360 G, and 480 G were used for the first experiment. A force of 360 G was chosen for two other experiments; this force is equivalent to the distraction rate of 0.5 mm per day of a jackscrew device. The ring-shaped suture expander was opened and its two feet were fixed in the medial sides of residual horizontal plates of the palatine bones immediately after a hard palate cleft was constructed surgically under endotracheal general anesthesia. At the eighth postoperative day, under the traction of 360 G, the two sides of the 8-mm-wide hard palate cleft were brought into contact with each other, and 8 or 9 days later the closed palatal cleft had healed completely with mucosal tissue. This experiment was repeated twice and yielded the same results. Sutural expansion osteogenesis was evaluated physically, fluorescently, histologically, and ultrastructurally to examine the deposition of the regenerated bone in the suture areas. Additionally, the influence of sutural expansion osteogenesis of the palatal bones on other facial bones was also studied cephalometrically. In Part II, a bow-shaped suture expander made of nickel-titanium shape memory alloy was applied to expand either the left or the right side of the transverse palatal suture of each of the experimental dogs. At the postoperative week 4 to 6, the maxillary segment was moved forward 5 to 6 mm on the expanded side, and the palatal bone was pushed backward 5 mm. The changes of bone position were assessed radiographically and cephalometrically. Tissue response of circum-maxillary sutures was examined histologically. These experiments led to the following conclusions: (1) Bony closure of the surgically constructed hard palate cleft with a ring-shaped suture expander made of nickel-titanium shape memory alloy is possible. (2) Anterior advancement of the maxillary segment and posterior lengthening of the hard palate using a bow-shaped suture expander made of nickel-titanium shape memory alloy applied at the palatomaxillary suture (transverse palatal suture) of the hard palate are also possible. Thus, in humans, a new approach for cleft palate repair may be a worthwhile investigation.
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Affiliation(s)
- C Liu
- Plastic Surgery Hospital and Institute of the Chinese Academy of Medical Sciences, Beijing, People's Republic of China
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McCarthy JG. Sutural Expansion Osteogenesis for Management of the Bony-Tissue Defect in Cleft Palate Repair: Experimental Studies in Dogs. Plast Reconstr Surg 2000; 105:2026-2027. [PMID: 11242333 DOI: 10.1097/00006534-200005000-00017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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