Craniofacial Distraction

This book, edited by a leading pioneer of craniofacial distraction, summarizes the progress achieved in the field in a way that will serve the needs of the practicing clinician. All components of the craniofacial anatomy are covered and all topics are discussed in depth: clinical and anatomic pathology, diagnostic studies, treatment protocols, preoperative planning (including the latest virtual programs), device selection, operating room technical considerations, postoperative management, and intermediate/long-term follow-up. Relevant and timely studies from the literature are cited. The book is excellently illustrated, with many patient photos, radiographs, and drawings. Craniofacial Distraction will be a superb, up-to-date resource for a wide range of practitioners, including maxillofacial surgeons, craniofacial surgeons, plastic surgeons, head and neck surgeons, pediatric surgeons, orthodontists, prosthodontists, and pedodontists. Foreword 5 Memories 5 Paleoconcepts 5 Jubilation 6 Panoramic Perspectives 6 Thank You 6 Preface 7 Contents 11 1: Craniofacial Distraction: A Personal Odyssey 12 The Biomedical Research of Today Is the Clinical Medicine of Tomorrow. Without It the Clinical Medicine of Tomorrow Will Be the Clinical Medicine of Today 17 Glossary 18 References 19 2: Distraction Osteogenesis: Biologic and Biomechanical Principles 22 2.1 A Brief History 22 2.2 Classification of Distraction Osteogenesis 23 2.3 Phases of Distraction Osteogenesis 25 2.4 Biology of Bone Formation, Fracture Healing, and Distraction Osteogenesis 26 2.4.1 Pathways of Bone Development 27 2.4.2 Pathways of Appendicular Bone Fracture Healing 31 2.4.3 Pathways of Craniofacial Skeletal Fracture Healing 34 2.4.4 Physiologic Aspects of Distraction Osteogenesis on Bone Healing 35 2.4.5 Molecular Aspects of Distraction Osteogenesis on Bone Healing 37 2.4.6 Angiogenesis in Distraction Osteogenesis 39 2.4.7 Contrasting Bone Formation by Fracture Healing and Distraction Osteogenesis 40 2.5 Biomechanics of Distraction Osteogenesis 41 2.6 Mechanotransduction and Mechanocoupling 43 2.7 Advances of Distraction Osteogenesis in the Craniofacial Skeleton 44 References 46 3: Distraction of the Mandible 55 3.1 Bilateral Mandibular Distraction 56 3.1.1 Pathology 56 3.1.1.1 Pierre Robin Sequence (PRS) 56 3.1.1.2 Bilateral Craniofacial Microsomia (BCFM) 57 3.1.1.3 Treacher Collins Syndrome (TCS) 58 3.1.2 Indications 58 3.1.2.1 Absolute Indications 58 3.1.2.2 Controversial Indications 59 3.1.3 Preoperative Assessment 59 3.1.3.1 Age of Patient/Patient and Family Cooperation 59 3.1.3.2 Health of Patient 60 3.1.3.3 Respiratory Status/OSA 60 3.1.3.4 Alimentation 60 3.1.3.5 Bone Volume and Blood Supply 60 3.1.3.6 Dentition 62 3.1.3.7 Concomitant Temporomandibular Joint Disorder (TMJD) or TMJ Ankylosis 63 3.1.3.8 Associated Maxillary Deficiency 63 3.2 Orthodontic Assessment 65 3.2.1 Preoperative Planning 65 3.2.2 Operative Technique 70 3.2.3 Postoperative Management 72 3.3 Case Examples (Figs. 3.16, 3.17, 3.18, 3.19, 3.20, 3.21, and 3.22) 72 3.3.1 Complications 79 3.3.2 Outcomes/Longitudinal Studies 80 3.4 Unilateral Mandibular Distraction 82 3.4.1 Pathology 82 3.4.2 Indications 84 3.4.2.1 Absolute Indications 84 3.4.2.2 Controversial Indications 84 3.4.3 Preoperative Assessment 84 3.4.4 Orthodontic Assessment 84 3.4.5 Preoperative Planning 85 3.4.6 Operative Technique 85 3.4.7 Postoperative Management 85 3.5 Case Examples (Figs. 3.27, 3.28, 3.29, and 3.30) 88 3.5.1 Complications 88 3.5.2 Outcomes/Longitudinal Studies 93 References 96 4: Mandibular Distraction, Orthodontic Considerations 99 4.1 Introduction 99 4.2 Preoperative Evaluation 99 4.2.1 Diagnostic Records 100 4.3 Selection of Distraction Device 100 4.4 Pre-distraction Orthodontic Therapy 100 4.5 Selection of Vectors of Distraction 101 4.5.1 Horizontal Vector Device Placement 101 4.5.2 Vertical Vector Device Placement 102 4.5.3 Oblique Vector Device Placement 102 4.6 3D Planning of Distraction 102 4.7 Orthodontic Therapy During the Activation Phase 103 4.7.1 Molding of the Generate 104 4.8 Orthodontic Therapy During the Consolidation Phase 105 4.9 Orthodontic Therapy Post-Consolidation Phase 105 4.10 Long-Term Outcome of Mandibular Distraction 106 References 108 5: Intraoral Mandibular Distraction 109 5.1 Mandibular Widening by Distraction 110 5.1.1 Preoperative Assessment 110 5.1.1.1 Dental Model Analysis 110 5.1.1.2 Soft Tissue Skeletal Analysis 110 5.1.2 Surgical Planning 110 5.1.3 Widening the Symphysis or Parasymphyseal Region 113 5.1.4 Combined Mandibular Widening and Genioplasty 113 5.1.5 Distraction Protocol [2, 5, 7–13] 114 5.1.6 Variables 115 5.1.7 Postoperative Care 115 5.2 Mandibular Lengthening by Distraction 115 5.2.1 Clinical Indications 116 5.2.2 Surgical Procedures [19–26] 116 5.2.2.1 Ramus Sagittal Split Osteotomy [19–25] 116 5.2.2.2 Body Osteotomy (Anterior to the Mental Nerve) [19–26] 118 5.2.3 Postoperative Considerations 121 5.2.4 Postsurgical Orthodontics 121 5.2.4.1 Horizontal Ramus Osteotomy [19–26] 121 5.2.4.2 Combinations 122 5.3 Bone Transport by Intraoral Distraction 125 5.3.1 Indications 125 5.3.2 Preoperative Planning 125 5.3.3 Principles 126 5.3.4 Multifocal Distraction [35–37] 126 5.3.5 Distraction Protocol 128 5.3.6 Docking Site Surgery [32, 38–44] (Fig. 5.10) 128 5.3.7 Dental Implants in Bone Transport 129 References 129 6: Distraction of the Maxilla (Le Fort I) 133 6.1 Indications 133 6.2 Internal Devices vs. External Devices 134 6.3 Preoperative Planning 136 6.4 Operative Technique 139 6.5 Postoperative Care and Orthodontic Manipulation 139 6.6 Complications 141 6.7 Outcomes 141 References 143 7: Distraction of the Midface: Le Fort III and Monobloc 144 7.1 Pathology 145 7.2 Indications 145 7.3 Preoperative Assessment 146 7.3.1 Physical Examination 146 7.3.2 Ophthalmology Assessment 147 7.3.3 Respiratory Evaluation 147 7.3.4 Photography 147 7.3.5 Cephalograms 147 7.3.6 CT Scans 148 7.3.7 Other Key Variables 148 7.3.7.1 Age of Patient 148 7.3.7.2 General Health 148 7.3.7.3 Bone Volume/Quality 148 7.4 Orthodontic Assessment 149 7.5 Preoperative Surgical Planning 149 7.6 Operative Technique 151 7.6.1 Monobloc Distraction (Fig. 7.4) 151 7.6.2 Le Fort III Distraction (Subcranial) (Fig. 7.6) 154 7.6.3 Vector Control 156 7.6.4 Variations in Technique 157 7.7 Postoperative Period 158 7.7.1 Latency 158 7.7.2 Activation 159 7.7.3 Consolidation 161 7.7.4 Orthodontic Management/Molding of Generate 161 7.8 Le Fort III Case Reports (Figs. 7.12, 7.13, 7.14, 7.15, 7.16, 7.17, 7.18, 7.19, 7.20, 7.21 and 7.22) 161 7.9 Monobloc Case Reports (Figs. 7.23 and 7.24) 174 7.9.1 Complications 176 7.10 Clinical Outcomes/Longitudinal Follow-Up 178 References 181 8: Facial Bipartition Distraction 185 8.1 Introduction 185 8.2 Bipartition Distraction Technique 186 8.2.1 Presurgical Orthodontic Preparation 186 8.2.2 Surgical Technique 187 8.3 Outcomes of Bipartition Distraction 191 8.3.1 Postoperative Occlusal Issues 193 8.3.2 Complications 193 8.4 Geometric Morphometrics 194 8.5 Alternative Surgical Approaches to Correct the Apert Face 195 References 197 9: Midface Distraction: Orthodontic Considerations 199 9.1 Introduction 199 9.2 Preoperative Evaluation 200 9.2.1 Diagnostic Records 200 9.3 Predistraction Orthodontic Therapy 200 9.4 Splint Construction for LeFort III or Monobloc Distraction: Traditional 201 9.5 Splint Construction for LeFort III or Monobloc Distraction: Rigid 202 9.6 Orthodontic Therapy During Activation 203 9.6.1 Control of the Position of the Osteotomized LeFort III 203 9.7 Outcomes 206 9.7.1 Skeletal Changes 206 9.7.2 Comparison Between Traditional (Acute) and Distraction Midface Procedure 207 9.7.3 Soft Tissue Changes Following Distraction 207 9.7.4 Five-Year Follow-Up 208 9.7.5 Airway Changes Following Distraction 208 References 209 10: Distraction of the Cranial Vault 210 10.1 Introduction 210 10.2 Benefits and Mechanisms of Cranial Vault Distraction 211 10.2.1 Mechanism of Ossification 211 10.3 Device Selection 212 10.3.1 Springs 212 10.3.2 Magnetism 213 10.4 Posterior Vault Expansion 213 10.4.1 Surgical Technique 215 10.5 Middle Vault Expansion 220 10.5.1 Surgical Technique 220 10.6 Anterior Vault Expansion 222 10.6.1 Unicoronal Craniosynostosis (UCS) 222 10.6.2 Surgical Technique 222 10.6.3 Metopic Craniosynostosis 224 10.6.4 Surgical Technique 226 10.7 Total Cranial Vault Expansion 229 10.8 Complications 231 References 232 Front Matter....Pages i-xi Craniofacial Distraction: A Personal Odyssey....Pages 1-10 Distraction Osteogenesis: Biologic and Biomechanical Principles....Pages 11-43 Distraction of the Mandible....Pages 45-88 Mandibular Distraction, Orthodontic Considerations....Pages 89-98 Intraoral Mandibular Distraction....Pages 99-122 Distraction of the Maxilla (Le Fort I)....Pages 123-133 Distraction of the Midface: Le Fort III and Monobloc....Pages 135-175 Facial Bipartition Distraction....Pages 177-190 Midface Distraction: Orthodontic Considerations....Pages 191-201 Distraction of the Cranial Vault....Pages 203-227