Distraction Osteogenesis Surgery
Distraction osteogenesis refers to a surgical technique designed to address defects and deficiencies in the skeleton. For over 40 years the orthopedic community has employed distraction osteogenesis techniques to lengthen and reconstruct arms & legs.
Distraction surgery was first reported to treat defects of the oral and facial region in 1990. Since then, the surgical and technological advances made in the field of distraction osteogenesis have provided oral and maxillofacial surgeons with a safe and predictable method to treat selected deformities of the oral and facial skeleton.
The first devices used for distraction surgery of the upper & lower jaws were large and protruded through the patient’s skin. The results were often satisfactory, but the facial scars and esthetic compromise of such devices made the process an option for only the more extreme cases. In the last few years the technology of distraction devices has progressed to the point where the distraction devices are all intra-oral; thus avoiding the unsightly facial scars.
Recently, new distraction devices have been developed to permit this nascent technique to be employed in the growth of bone for dental implants. In such cases a small section of the jaw bone is surgically cut and then gently distracted to grow both height &/or width of bone. After a short healing period dental implants can be placed.
In most distraction cases the need for extensive bone grafting is eliminated. The final result, be it advancement of the jaws or the growing of bone for implants, is often reached in less time than with grafting, with superior results, and less patient discomfort.
Frequently Asked Questions About Distraction Osteogenesis
What does the term distraction osteogenesis mean?
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.
Is the surgery for distraction osteogenesis more involved than “traditional surgery” for a similar procedure?
No. Distraction osteogenesis 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.
Will my insurance company cover the cost of distraction osteogenesis surgical procedure?
Most insurance companies will cover the cost of the surgical procedure provided there is adequate and accurate documentation of the patient’s condition. Of course, individual benefits within the insurance company policy vary. After you are seen for your consultation at our office, we will assist you in determining whether or not your insurance company will cover a particular surgical procedure.
Is distraction osteogenesis painful?
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 analogous to having braces tightened.
What are the benefits of distraction osteogenesis versus traditional surgery for a similar condition?
Distraction osteogenesis surgical procedures typically produce less pain and swelling than the traditional surgical procedure for a similar condition. Distraction osteogenesis eliminates the need for bone grafts, and therefore, another surgical site. Lastly, distraction osteogenesis is associated with greater stability when used in major cases where significant movement of bony segments are involved.
What are the disadvantages of distraction osteogenesis?
Distraction osteogenesis requires the patient to return to the surgeon’s office frequently during the initial two weeks after surgery. This is necessary because in this time frame the surgeon will need to closely monitor the patient for any infection and teach the patient how to activate the appliance.
Can distraction osteogenesis be used instead of bone grafts to add bone to my jaws?
Yes. Recent advances in technology have provided the oral and maxillofacial surgeon with an easy to place and use distraction device that can be used to slowly grow bone in selected areas of bone loss which has occurred in the upper and lower jaws. The newly formed bone can then serve as an excellent foundation for dental implants.
Does distraction osteogenesis leave scars on the face?
No. The entire surgery is done within the mouth and the distraction devices used by Dr. Whitesides remain inside the mouth. There are no facial surgical incisions made so no unsightly facial scars result.
Are there any age limitations for patients who can receive osteogenesis?
No. distraction osteogenesis works well on patients of all ages. In general, the younger the patient the shorter the distraction time and the faster the consolidation phase. Adults require slightly longer period of distraction and consolidation because the bone regenerative capabilities are slightly slower than those of adolescence or infants.
Hemifacial microsomia (HFMS) is the second most common facial birth defect. Its exact cause is undetermined at this time; however, researchers believe a disruption in the blood supply to the jaws in the first trimester may produce HFMS. Children with HFMS are born with a deformed mandible (lower jaw). The jaw deformity is characterized by an asymmetry of the mandible secondary to a failure of one side of the mandible to grow. Additionally, the failure of the mandible to grow produces an accompanying deformity of the upper jaw (maxilla) on the same side. As the child grows the deformity becomes more noticeable as the chin is off to the affected side & the child’s “bite” is off centered. The degree of deformity varies with each child.
Since HFMS produces a defect of the hard (bone) and soft tissue, facial asymmetry is noticeable in even minor cases and often accentuated in the most extreme cases. Accompanying findings of patients with HFMS include a missing ear, hearing loss, weakness of the facial nerve, and abnormal orbit size.
Treatment of HFMS
The treatment of children and adults with this condition varies with each case and should be tailored to each patient’s particular needs. Years ago the standard of care was to take a rib from the patient and graft it to the affected side. As the patient grew, so did the rib. Many times this worked well; however in a significant number of cases the rib either grew faster or slower than the jaw producing an asymmetric jaw.
Today surgeons have an alternative to the rib graft procedure: Distraction Osteogenesis Surgery (DOS). In DOS the patient’s deformed bone is surgically cut then a small distraction device is affixed to the bone.
After a week of healing the distraction device is activated daily and the two bone segments are slowly separated. Once the distraction process is completed a consolidation period takes place where the bone grows in the gap created by the separation of the two bone segments. After the bone has sufficiently regenerated the distraction device may be removed. Advantages of DOS in treating HFMS include:
- Suitable for children & adults
- Generation of bone and soft tissue
- Minimally traumatic surgery
- Elimination of the need of bone grafting
DOS has been shown to successfully address the reconstruction needs of patients with HFMS. Although long term follow in DOS for HFMS is currently unavailable, results thus far are encouraging. In addition to DOS to reconstruct the facial bones patients will need the skill and care of a qualified Plastic & Reconstructive surgeon to address the missing ear, which occurs with HFMS. The general dentist and orthodontist are also valuable members of the team in these patients. Both of these dental professionals will work with the Oral & Maxillofacial surgeon to ensure that the appropriate dental and skeletal relationship will be obtained as treatment is completed.