What is Distraction Osteogenesis?

Distraction osteogenesis of the craniofacial skeleton is a new technique whereby extensive jaw surgery can be accomplished with less invasive techniques. Initially invented by a surgeon working in Russia for orthopedic limb lengthening, devices have been applied to the lower and upper jaws

to allow gradual repositioning of the facial bones. These techniques may be especially suitable in younger children. In children with very small lower jaws, who have difficulty breathing and who have obstructive sleep apnea, mandibular advancement may be carried out by the technique of

distraction osteogenesis. This often obviates the need for more complex surgery and lessens the hospital stay. As instrumentation improves, these techniques will become less invasive, more widespread, and more suitable for patients with simpler dentofacial deformities.

The device that stretches the bone is placed over the cut made in the bone. Most of the devices are placed under the skin next to the bone (internal or buried devices). Occasionally, external devices are used if the jawbone is very small. After the initial operation, a callus is allowed to form for three to four days at the site of the bone cut. The distraction process begins after this waiting period and usually occurs at 1 or2mm per day. The parents complete the distraction at home. Weekly visits are made to the office during this time. The movements are small but add up very quickly. After the distraction is completed, the new bone is allowed to heal (4-6 weeks) and then the device is removed with an outpatient procedure.

This technique has been used very successfully in patients with small jaws, especially if there is a breathing problem because of the small jaw, or the patient has a tracheostomy.  The lower jaw is expanded, making more room for the tongue. The technique is also very useful in patients with a small jaw on one side (hemifacial microsomia). Again, the jaw on one side is expanded so the chin is moved to the middle and the teeth have a better fit. The technique has been used in patients with severe Pierre Robin sequence,Treacher Collins syndrome, Nagers, and bilateral small jaws.  Another very good application for this technique is to expand the middle portion of the face (nose, cheeks, and upper jaw). Patients with cleft lip and palate deformities often have small upper jaws and l lot of scarring which makes advancement difficult. This technique is effective in countering the forces of the scar. Babies with breathing problems because of a small nasal passage can often undergo distraction of the midface to prevent a tracheostomy. This technique is very effective in patients with other syndromes such as Apert’s, Crouzon, and Binder’s Syndrome.