Distraction osteogenesis is a relatively new method of treatment for selected deformities and defects of the oral and facial skeleton, having been used to treat such defects since 1990. Since then, the surgical and technological advances made in the field of distraction osteogenesis have provided Oral & Maxillofacial Surgeons with a safe and predictable method to treat selected deformities of the oral and facial skeleton.
At the WK Oral and Maxillofacial Surgery Institute, our surgeons use distraction osteogenesis to treat selected deformities and defects of the oral and facial skeleton. It is generally used to treat conditions known as midface and mandibular hypoplasia, or abnormally slow growth of the upper two thirds and lower third of the face, respectively. Our surgeons commonly use distraction osteogenesis for the treatment of adolescents with cleft palate when their upper jaw has not grown properly (Le Fort I maxillary advancement), in younger children with Crouzon, Apert, or other craniosynostosis syndromes when their entire upper face has not developed properly (Le Fort III midface advancement), and in children of any age, from newborn to teenager, when their lower jaw has not formed properly and is causing problems (mandible or lower jaw distraction). Distraction osteogenesis works well on patients of all ages. In general, the younger the patient the shorter the distraction time and faster the consolidation phase. Adults require a slightly longer period of distraction and consolidation because the bone regenerative capabilities are slightly slower than those of adolescence or infants.
Simply stated, distraction osteogenesis means the slow movement apart (distraction) of two bony segments in a manner such that new bone is allowed to fill in the gap created by the separating bony segments. Our surgeons first make an osteotomy (break) in an abnormal bone and attach a device known as a distractor to both sides of the break. The distractor is gradually adjusted over a period of days or weeks to stretch the break so new tissue fills it. Once the bone is in the desired position, it is held in place and the regenerated tissue is allowed to heal and turn into new bone, forming longer bone from a shorter one. Once the new bone is strong enough, we remove the device during a very short second operation.
The surgery is usually done on an outpatient basis with most of the patients going home the same day of surgery. The surgical procedure itself is less invasive so there is usually less pain and swelling. Since all distraction osteogenesis surgical procedures are done while the patient is under general anesthesia, pain during the surgical procedure is not an issue. Postoperatively, you will be supplied with appropriate analgesics (pain killers) to keep you comfortable, and antibiotics to fight off infection. Activation of the distraction device to slowly separate the bones may cause some patients mild discomfort. In general, the slow movement of bony segments produces discomfort roughly similar to having braces tightened. You will be required to return to our office frequently during the initial two weeks after surgery for close monitoring as well as to help teach you how to activate the device yourself.
Most often the entire surgery is performed within the mouth and the distraction devices used remain inside the mouth. Rarely, there may be a small incision located behind the ear for the distractor to exit, facilitating activation daily. This incision heals very well with minimal if any residual scarring.