Ilizarov technique in Maxillary Alveolar Distraction: A report of three patients. O’Connell J, Kearns G. Department of Oral and Maxillofacial Surgery, Mid Western Regional Hospital, Limerick. Introduction Distraction Osteogenesis (DO) was first described by Von Langenbeck 1in 1869 and later by Codivilla2 in 1905, and is defined as the process of generating new bone in a gap, created by osteotomy, between two bone segments in response to the application of graduated tensile stress across the gap3. The technique remained under-developed until a series of experimental and clinical studies4, 5 performed in the 1950’s in Western Siberia by the Russian surgeon Ilizarov, advanced the technique. He successfully applied DO to the endochondral bone of the upper and lower limbs. Uniquely, bone regeneration by DO is accompanied by simultaneous expansion of the functional soft tissue matrix, including blood vessels, nerves, skin, muscle, mucosa, fascia, ligaments, cartilage and periosteum6. The application of DO in the maxillofacial complex, as an alternative to orthognathic surgery, began in 1973 with Snyder et al7 and in1977 with Micheili et al8 who reported on mandibular elongation in dogs. In 1992, McCarthy et al9 reported the use of distraction to treat patients with hemifacial microsomia and Nagar syndrome. DO is now used for vertical augmentation of the alveolar ridge10, surgical palatal expansion11, anterior advancement in maxillary hypoplasia12, correction of congenital facial abnormalities13, treating cleft patients14, mandibular symphysis elongation15, and mandibular reconstruction after tumour reconstruction16. Chin and Toth17 described alveolar distraction osteogenesis(ADO) in 1996. This technique is used for increasing alveolar bone where rehabilitation with dental implants is required. Some of the advantages of ADO, compared with the conventional techniques of bone grafting and guided tissue regeneration, are decreased bone resorption, no donor site morbidity, and associated soft- tissue regeneration18. The purpose of this retrospective study was to analyse the outcome of ADO used to treat Anterior Maxillary Atrophy including vertical and horizontal defects, prior to placement of endosseous implants. Patients and Methods This is a review of 3 patients who underwent Alveolar Distraction Osteogenesis at the Oral and Maxillofacial Department, Mid Western Regional Hospital, Limerick. All patients were male, with a mean age of 34 years (range, 21 to 50 years). All had a diagnosis of anterior maxillary deficiency and loss of associated teeth, secondary to trauma. The absence of alveolar bone, in a horizontal and vertical direction, prevented the placement of endosseous implants used to enhance function and aesthetics. All patients were treated using the following protocol: 1) Creation of a three sided osteotomy in the maxillary alveolus and placement of the distractor under general anaesthesia. 2) Latency period of 5 days. 3) Distractor activation at a rate of 1mm per day. 4) Consolodation phase of 12 weeks. Following consolidation, the distractor was removed. Adequate vertical alveolar height was achieved in all cases. Horizontal bone deficiency was corrected using autogenous bone grafts (1 mandibular symphyseal and 2 iliac crest). Following bone graft healing of approximately four months, all patients underwent placement of dental implants with subsequent restoration of the dentition by their dentist. The mean follow up was 30 months (range, 3 to 36 months). Conclusion In patients with severe horizontal or vertical maxillary alveolar atrophy, the combination of Alveolar Distraction to increase vertical bone height and the associated soft tissue envelope followed by horizontal autogenous bone grafting, provides a predictable increase in alveolar bone volume to permit implant placement and restoration of the maxillary dentition. References 1 Von Langenbeck B. About the pathologic length growth of long bones and its employement in surgical praxis. Berl Klin Wochen Schr 1869; 26: 265. 2 Codvilla A. On the means of lengthening in the lower limbs, the muscles and tissues which are shortened through deformity. Am J Orthop Surg 1905; 2: 353-357. 3 Saulacic N, Lizuka M, Martin S, Garcia A. Alveolar distraction osteogenesis: a systematic review. Int. J Oral Maxillofac. Surg. 2008; 37:1-7. 4 Ilizarov GA. The tension-stress effect on the genesis and growth of tissues. Part 1. The influence of stability of fixation and soft-tissue preservation. Clin Orthop 1989; 238:249-281. 5 Ilizarov GA. The tension-stress effect on the genesis and growth of tissues. Part 2. The influence of the rate and frequency of distraction. Clin Orthop 1989; 239: 263-285. 6 Swennen G, Schliephake H, Dempf R, Schierle H, Malevez C. Craniofacial distraction osteogenesis: a review of the literature. Part 1: clinical studies. Int. J. Oral. Maxillfac. Surg. 2001; 30: 89-103. 7 Synder C, Levine G, Swanson H, et al. Mandibular lengthening by gradual distraction; A preliminary report. Plast Recosntr Surg 1973; 51: 506. 8 Michieli S, Miotti B: Lengthening of the mandibular body by gradual surgical-orthodontic distraction. J Oral Surg 1977; 35: 187. 9 McCarthy J, Schreiber J, Karp N, et al: Lengthening the human mandible by gradual distraction. Plast Reconstr Surg 1992; 89: 1. 10 Jensen O, Cockrell R, Kuhike L, Reed C. Anterior maxillary alveolar distraction osteogenesis: a prospective 5-year clinical study. Int J Oral Maxillofac Implants 2002; 17: 52-68. 11 Bell W, Epker B: Surgical orthodontic expansion of the maxilla. Am J Orthod 1976; 70: 517. 12 Dolanmaz D, Karaman A, Ozyesil A. Maxillary anterior segmental advancement by using distraction osteogenesis: a acse report. Angle Orthod 2003; 73: 201-205. 13 Chin M: Distraction osteogenesis in maxillofacial surgey, in Lynch S, Genco R, Marx R (eds): Tissue engineering: Applications in Maxillofacial Surgery and Periodontics. Carol Stream, Quintessence, 1999, pp147-159. 14 Ko EWC, Figueroa A, Polley J: Maxillary advancement with distraction osteogenesis by use of a rigid external distraction device: A 1-year follow up. J Oral Maxillofac Surg 2000; 58:959. 15 Bell W, Harper R, Gonzalez M, et al: Distraction osteogenesis to widen the mandible. Br j Maxillofac Surg 1997; 35:41. 16 Fukuda M, Iino M, Yamaoka K, et al: Two-stage distraction osteogenesis for mandibular segmental dfect. J Oral Maxillofac Surg 2004; 62: 1164. 17 Chin M, Toth B. Distraction osteogenesis in maxillofacial surgery using internal devices: review of five cases. J Oral Maxillofac Surg 1996; 54: 45-53. 18 Mazzonetto R, Allais M, Maurette P, Moreira R. A retrospective study of the potential complications during alveolar distraction osteogenesis in 55 patients. Int. J. Oral Maxillofac. Surg. 2007; 36: 6-10.
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