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Many facial reconstruction patients are children, so there is a great incentive to develop techniques that decrease trauma and the number of surgeries required to achieve a good outcome.
According to Dr. Leonard Kaban, chief of oral and maxillofacial surgery, approximately 85% of pediatric mandibular reconstruction patients require skeletal expansion, traditionally achieved with soft-tissue flaps or bone grafts harvested from a "donor" site such as the patient's own hip, skull, or ribs.
One of the most promising new techniques in mandibular reconstruction is distraction osteogenesis (DO), the gradual lengthening of bone using a specialized appliance (a "distractor") to place tension forces across an osteotomy. Candidates for this procedure are children with micrognathia, midface hyperplasia (cleft lip/palate, Crouzon or Apert syndrome), and those with acquired conditions resulting from trauma, tumor resection, or radiation therapy.
The benefits of DO can be numerous. In addition to avoiding donor-site morbidity, the procedure can be performed using minimally invasive techniques, sometimes endoscopically. Studies show that DO permits the jaw to be moved greater distances than with conventional surgery and that the newly created bone appears to be more stable.
DO's journey from bench to bedside represents scientific collaboration at its best, working in partnership with industry, federal grants, the Skeletal Biology Research Center (headed by Dr. Maria Troulis), and the Harvard Surgical Planning Laboratory.
"In the future," Dr. Kaban notes, "skeletal expansion in the craniomaxillofacial region will be achieved with far less morbidity, greater patient comfort, and more predictable, higher quality outcomes."
Magill J, Goldwaser B, Troulis MJ, Kaban LB. Automating skeletal expansion: An implant for distraction osteogenesis of the mandible. J Medical Devices, 3, 014502 (2009).
Kaban LB, Seldin EB, Kikinis R, Yeshwant K, Padwa BL, Troulis. MJ. Clinical application of curvilinear distraction for correction of mandibular deformities. J Oral Maxillofac Surg, May 2009, 67(5), 996-1008.
Steinbacher DM, Kaban LB, Troulis MJ. Mandibular advancement by distraction osteogenesis for tracheostomy-dependant children with severe micrognathia. J Oral Maxillofac Surg 63(8):1072-1079, 2005.
Yeshwant K, Seldin EB, Gateno J, Everett P, White CL, Kikinis R, Kaban LB, Troulis MJ. Analysis of skeletal movements in mandibular distraction osteogenesis. J Oral Maxillofac Surg 63:335-340, 2005.
Thurmueller P, Troulis MJ, Rosenberg A, Chuang SK, Kaban LB. Microscopic changes in the condyle and disc in response to distraction osteogenesis of the minipig mandible. J Oral Maxillofac Surg: 62:249-58, 2005.
Yeshwant K, Seldin EB, Kikinis R, Kaban LB. A computer-assisted approach to planning multidimensional distraction osteogenesis. Atlas Oral Maxillofac Surg Clin N Am 2005;13:1-12.
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