Distraction Osteogenesis (DO) is the surgical technique in which new bone formation is stimulated by the gradual separation of bony segments after an osteotomy. Distraction procedures for the facial skeleton are relatively new, being first reported in the English literature in 1992. The surgery involves placement of a device across a surgical site and after a suitable period of healing, (usually one week) the device is activated at a rate of one millimeter per day. New bone is laid down as the segments are separated and a greater degree of bone lengthening can be gained than by conventional surgery. A healing period is necessary prior to removal of the distractors (about four months). The devices we use at Face and Jaw Surgery are placed internally as opposed to unsightly external appliances. DO is reserved for difficult situations where there is need for large bony movement or where there is not a reasonable conventional alternative.
Case 1
Ten-year-old male, diagnosis of hemifacial microsomia, type III. Patient had reconstruction of lower jaw with rib graft at age 5. Internal distractor utilized to correct facial asymmetry.
Pre-op Frontal Photo
Post-op Frontal Photo
Panoramic radiograph showing distractor in place
Panoramic radiograph post removal showing well healed bone in area of distractionCase 2
Seven year old patient with diagnosis of mild Treacher-Collins Syndrome. History of severe snoring and marked mandibular hypoplasia. Stereolithographic models were obtained for treatment planning. Patient had bilateral osteotomies, mandibular lengthening of 15 mm.
Pre-op Lat
Post-op
Pre-op model
Post-op modelCase 3
17 year old patient with transverse hypoplasia in max and mand arches. Surgically assisted rapid palatal expansion and mandibular expansion utilizing distraction.
Pre-op frontal view
Post-op frontal view
Pre-op Occlusion
Post-op Occlusion
Pre-op Mand Arch
Post-op Mand Arch
Pre-op Max Arch
Post-op Max Arch