GOOD MORNING
DISTRACTION
OSTEOGENESIS
INTRODUCTION:
•Distraction Osteogenesis is an innovative treatment option in
cranio- maxillo -facial surgery. It is a means of stimulating
production of new bone. In this procedure, the jaw bone is cut
and the two arms of the distractor device are attached to the
cut bone segments.
DEFINITION:
Distraction osteogenesis (DO), also called callus
distraction, callotasis and osteodistraction, is a process
used in orthopedic surgery, pediatric surgery, and
oral and maxillofacial surgery to repair skeletal deformities and
in reconstructive surgery.
The procedure involves cutting and slowly separating bone,
allowing the bone healing process to fill in the gap.
USES:
(1) Deficient maxilla or midface,
(2) Deficient hypoplastic mandible,
(3) Deficient alveolar bone prior to implants placement.
.
ILIZAROV EFFECTS
The first Ilizarov principle postulates that gradual traction
creates stress that can Stimulate and maintain regeneration
and active growth of living tissue.
The second Ilizarov principle stated that the shape and
mass of bones and joints are dependent on an interaction
between mechanical loading and blood supply.
If blood supply is inadequate to support normal or increased
mechanical loading, then the bone cannot respond
favorably, leading to atrophic or degenerative changes.
DISTRACTION OSTEOGENESIS
(CALLOTASIS)CONSIST OF FIVE
SEQUENTIAL PERIODS:
OSTEOTOMY
LATENCY
DISTRACTION
CONSOLIDATION
REMODELLING
PHASES:
OSTEOTOMY PHASE
Divides the bone into two segments.
Triggers process of bone repair.
Angiogenesis
Fibrogenesis
Osteogenesis
PHASES(CONTD.)
LATENCY PHASE
Period from bone
division to onset of
distraction.
Inflammation and soft
callus formation of the
fractured bone.
Soft callus formation
begins in 3-7 days and
lasts 2-3 weeks.
Latency period=5-7 days
PHASES(CONTD.)
DISTRACTION
PHASE
Characterized by the
application of traction
forces to osteomized
segments.
Rate:1mm/day
Rhytm:0.25mm every 6
hours;0.5mm twice a day
Duration:1-3 weeks
PHASES(CONTD.)
CONSOLIDATION
PHASE
Cessation of traction forces
to removal of distractor
Newly formed bone
mineralises and increases in
bone density and strength.
Duration:3-4 months
PHASES(CONTD.)
REMODELLING
PHASE
Removal of distractor
to application of
functional loading.
Formation of lamellar
bone.
EXTERNAL INTERNAL
DEVICE DEVICE
USES:
Lengthen the lower jaw.
Correcting anterior-posterior deformity
of the jaws.
Trauma reconstruction.
Cancer reconstruction.
Craniofacial syndromes.
Increasing bone width and height of
teeth bearing region of upper or lower
jaw for dental implants.
INDICATIONS:
In children with craniofacial/ hemifacial
microsomia.
Simultaneous maxillary- mandibular distraction.
In children with significant bilateral mandibular
hypoplasia.
Neonatal distraction.
Children with severe midfacial deformities in the
context of facial clefts and craniofacial
conditions may also benefit from distraction.
CONTRAINDICATIONS:
Generalised bone disorders
Poor patient compliance.
History of poor fracture healing.
Aggressive jaw tumor.
Pre existing TMJ disorders.
Unwilling patients
Long duration treatment strategy.
ADVANTAGES:
Minimal likelihood of relapse.
Increased stability with large movements.
Simultaneous expansion of soft tissue.
Decreased operative time.
Decreased blood loss and morbidity
associated with bone grafts.
DISADVANTAGES:
Device failure.
Cutaneous scars with external pin-based
devices.
Limited control of the distracting vector
with internal devices.
Patient compliance and acceptance of the
device.
COMPLICATIONS:
Injury to the developing tooth follicles (e.g.,
maxillary and mandibular osteotomies).
Injury to various branches of the facial or
trigeminal nerves (e.g., the inferior alveolar
nerve with mandibular distraction)..
Pin site infection with external devices or
semi buried devices.
Nonunion and premature fusion.
Psychosocial issues related to the recovery.
COMPLETE RECONSTRUCTION OF MANDIBLE
CONCLUSION:
Distraction Osteogenesis is a fairly new
procedure in orthognathic surgery,
providing a way to treat deformities of the
oral and facial skeleton. It can be
performed on patients of all ages.
THANK YOU
