Distraction Osteogenesis For Oral And Facial Skeletal Deformities

A medical procedure that was once restricted to the annals of science fiction has cropped up in real-life, offering hope to those affected by severe oral and facial skeletal deformities. Distraction osteogenesis (DO), a groundbreaking technique, is revolutionizing orthognathic surgery by allowing for the gradual correction and expansion of skeletal structures.

In this extensive guide, we will delve into everything you need to know about DO, its applications, benefits, and what to expect before, during, and after the procedure.

Unveiling the Science of Distraction Osteogenesis

The Birth of a Technique

Distraction osteogenesis is not merely a surgical procedure; it's a biological phenomenon that exploits the body's innate ability to regenerate new bone. Initially intended to correct limb length discrepancies, it later found applications in the oral and facial regions.

Understanding the Mechanism

DO begins with a surgical osteotomy—a precise cut made in the bone, which does not sever the bone completely. Over the following days or weeks, a device called a distractor is adjusted regularly to facilitate the gradual separation of the bony segments. As this happens, the body naturally fills the gap with new bone, forming a longer or repositioned bone.

Expanding Horizons: Indications for Distraction Osteogenesis

Malocclusions and Maxillary Expansion

One of the most common applications of DO in oral and facial surgery is for the treatment of severe malocclusion (misalignment of teeth) and maxillary constriction. By using distractors, orthodontists and maxillofacial surgeons can expand the upper jaw, creating a more harmonious bite and facial profile.

Treating Craniofacial Syndromes

Craniofacial syndromes often result in a lack of growth in certain facial bones, leading to functional and aesthetic concerns. Distraction osteogenesis has become a preferred method for gradually and predictably correcting these skeletal abnormalities, giving patients a better chance at leading normal lives.

Cleft Lip and Palate Patients

Individuals with cleft lip and palate conditions may experience significant maxillary or mandibular defects, which can lead to speech issues and facial balance problems. DO offers a means of repairing these cleft-related deformities, often in conjunction with other surgical techniques and therapies.

The Procedural Experience: What to Expect

Pre-Surgery

Before undergoing distraction osteogenesis, extensive pre-operative planning is undertaken, often involving detailed imaging, such as cone beam computed tomography (CBCT) scans, to precisely map out the surgical and distraction plan. Patients and their families are thoroughly educated about the nature and course of the procedure.

Surgical Day

The actual procedure begins with the administration of anesthesia. The surgeon meticulously executes the osteotomy and places the distractors. The distractors have either an external or internal component: an arm or a screw. The external arm is visible and adjusted externally; the internal component requires a second, minor surgery to remove. The skin is then sutured, and the distractor is left in place.

The Distracting Phase

The postoperative period is marked by a latency phase, allowing for the bone to heal. After this, the distracting phase begins with the gradual turning of the distractor, usually at the rate of about 1 millimeter per day. This can be slightly uncomfortable for the patient but is generally well-tolerated.

Consolidation and Removal

After the desired amount of distraction has occurred, a consolidation phase begins, during which the bone undergoes significant remodeling and hardening. This phase is critical for ensuring the new bone's strength and stability. The distractor is eventually removed in a straightforward, usually outpatient procedure.

Life After Distraction Osteogenesis

Rehabilitation and Recovery

Rehabilitation following DO involves a period of physical therapy and close monitoring for new bone formation. Patients often report feeling a noticeable difference in the affected area's functionality and appearance after the distractors are removed, signaling the success of the procedure.

Long-Term Outcomes

The ultimate goal of DO is to furnish patients with life-long benefits, including improved oral function, speech, aesthetics, and in some cases, alleviating breathing difficulties associated with certain deformities. The long-term success of the procedure relates to the patient's individual healing capabilities and adherence to post-operative care instructions.

Distraction osteogenesis has undeniably carved a path for itself in the annals of modern medicine. If you or someone you know is considering DO, contact The San Diego Center for Oral & Maxillofacial Surgery to learn more.