What Is Distraction Osteogenesis?
Distraction osteogenesis is an advanced surgical technique used to lengthen short and/or deformed bones using a metallic distractor device. In the facial region, it may be used to correct or reconstruct underdeveloped / atrophied / resected jaw bones.
Why Distraction Osteogenesis Is Done?
You may need distraction osteogenesis if you have a:
- Repaired cleft palate with a small upper jaw
- Small lower jaw and breathing difficulty (obstructive sleep apnea)
- Severe facial asymmetry (hemifacial microsomia)
- Reduced jaw bone height for placement of dental implants
- Jaw defect requiring reconstruction after jaw tumor resection
What Distraction Osteogenesis Can / Can’t Do
- Augment tissue using an individual’s own bone, not any foreign or animal grafts
- Achieve much larger corrections than other augmentation surgical techniques
- Provide more stable resultsthan bone grafting procedures as it leads to soft tissue lengthening as well, reducing risk of relapse
- Makes reconstruction possible without requiring a donor site for bone harvesting elsewhere in the body
- The procedure cannot be used where bone volume is not enough to be lengthened
- It cannot be used to create deformities of excess, where a bone reduction / setback is required
How You Should Prepare For Distraction Osteogenesis ?
Facial distraction osteogenesis is a thoroughly planned surgical procedure. Before the surgery:
- Discuss your aesthetic and functional requirements with your surgeon
- Dental relationships usually change after distraction osteogenesis. Orthodontic treatment proceeds simultaneously with the surgery
- Familiarize yourself with the functioning of the distractor device. It will be your companion for a few weeks
- The process involves two surgeries, one for device fixation and another for device removal after a few weeks
- Discuss any medical illnesses, if you have, with your doctor
- Stop smoking for at least 2 weeks before the surgery
- Get an oral prophylaxis (scaling) 1 week before surgery to improve oral hygiene and surgical outcome
What is the Procedure of Distraction Osteogenesis ?
The procedure involves giving a surgical cut in the undersized bone (osteotomy) and fixing a distractor device across the cut using screws. Gradual activation of the device is begun a few days after surgery and leads to bone separation at the osteotomy, resulting in new bone formation in the gap created.
This effect results in lengthening of the bone and correction of the deformity. The activation continues for roughly 10-20 days after the surgery, depending on the extent of the deformity. After the desired clinical effect is achieved, the device is removed after a period of 6-12 weeks, to allow for bone strengthening.
At our centre, the use of piezosurgery for bone cutting prevents the risk of injury to vital nerves and teeth during surgery, making the entire treatment experience safer and more comfortable for the patient. Also, the distractor devices used are premium quality and steam sterilized to prevent any risk of infection.
The treatment planning done is meticulous and jaw correction is planned down to the exact millimeter. At our centre, the use of a simulation surgery software during planning allows the patient to be an integral part of the treatment plan and accurately predict the surgical outcome.
Recovery After Distraction Osteogenesis?
- Distractor fixation is generally a simple surgery. Only extensive cases may require hospitalization for 1-2 days
- A small part of the distractor device is left externally for regular activation for up to 12 weeks in some cases
- Device activation begins after 3-5 days after surgery and continues for a period of 10-20 days. This can be easily performed at home by you
- Mild facial swelling and slight discomfort is to be expected during device activation. This symbolizes new bone formation
- Solid foods and heavy exercise are to be avoided for up to 8 weeks after the surgery
- A period of jaw closure (intermaxillary fixation) may be required for a few weeks in cases with facial asymmetry.
- Regular saline rinses and cleaning of device are advised to maintain wound hygiene
- You may experience some transient numbness of the lip and nasal stuffiness in some cases
- Device removal is performed as a second surgery after 6-12 weeks
Risk involved in Distraction Osteogenesis?
- Lower jaw distraction osteogenesis may produce a small neck scar
- In the absence of good hygiene, wound infection may be rarely seen around the distractor device
- Poor quality distractor devices may loosen and fail
- Improperly planned surgeries may result in faulty direction of bone growth