The Use of Distraction Osteogenesis in Oral Surgery: Frequently Asked Questions

How do I know if I am a candidate?

The determination for the appropriateness of distraction as a treatment modality hinges primarily upon the severity and type of deformity and the ability of other means of treatment in being able to adequately correct it. Distraction is not a treatment of last resort but is most appropriate for the more severe types of deformities or patients who require treatment at an early age, which is inappropriate for more conventional therapy.

Many times, distractions can be used as an interventional treatment in childhood to allow more normal growth and development and prevent many other developmental delays and complications. We have had a great deal of success in the treatment of severely hypoplastic mandibular development in children. The majority of these children have been tracheostomy-dependent since birth. Many times, they remained tracheostomy-dependent until their teen years, when more conventional treatment was possible. Being able to eliminate their tracheostomy prior to the beginning of development of speech allows a more normal childhood and development with a better quality of life and health and reduced total medical care costs for the patient and family.

The use of maxillary distraction, particularly in the cleft palate population, has allowed us to achieve levels of correction that are unattainable by other methods. Through distraction, midface deficiency can be corrected to a normal position. In the past, we often camouflaged our results by treating both the upper and lower jaws, because we were unable to perform the correction adequately in the upper jaw.

Is this special training needed to perform this procedure?

Also, we can correct maxillary position at a younger age, normalizing occlusion and allowing for more normal midface growth after the completion of distraction. The basis for both maxillary and mandibular distraction are surgical techniques commonly associated with orthognathic surgery, which is used to correct both dental and facial deformities in teenagers and adults. The training necessary to perform these procedures pertains mainly to the surgical application of the devices, appropriate selection of the devices, modification of the osteotomies to produce the desired results, and control and modification of the vectors of distraction during the distraction period.

How many of these procedures have you performed?

During the past year, I performed approximately 20 of these procedures, equally split between the upper and lower jaws. They usually are appropriate only to one jaw in any given patient….or treatment phase.

Can this be done for over/under bites?

It may be utilized for the correction of midface or upper jaw deficiency which has resulted in an overbite and in some cases of underbite, particularly those involving facial asymmetries. The determination for the appropriateness of distraction vs. more conventional orthognathic procedures used to correct over/underbites can best be determined in consultation with the surgeon after evaluation of and determination of the severity of correction needed.

Distraction osteogenesis in the mandible and maxilla is an exciting new treatment modality that is an extension of the techniques developed by Ilizarov 50 years ago for the treatment of long bone deformities. It has become an accepted treatment in the orthopedic community for treatment in appropriate cases. During the 1990s, we have seen its development and now utilization in the correction of both cosmetic and functional dentofacial deformities. It is a rapidly developing and evolving area in which both new devices and new techniques are constantly being developed. As it continues to evolve, it offers hope for treatment of disabled children and those with deformities so severe that in the past they were uncorrectable.

As the technology develops, we are finding better, stronger, more adjustable devices that are allowing more conservative surgeries and lower rates of complications and morbidities. Distraction osteogenesis is not intended or meant as a replacement for more conventional and sometimes conservative techniques for the correction of dentofacial deformities. It is appropriate for use in younger populations and those at the more severe end of the scale of deformity. As with all new techniques, all the answers are not known…but as the pool of patients who have been treated grows, and the experience of the providers expands and those providing the techniques expands, ongoing dialogue will allow better understanding of the techniques, their goals and their limitations.