Search Results (9)

Introduction: Hemifacial hypoplasia is the second most common congenital craniofacial anomaly after cleft lip and palate. Mandibular ramus deficiency represents a key component of this condition, and vertical augmentation is traditionally managed with distraction osteogenesis. However, technical challenges related to device positioning and vector control continue to limit its reproducibility. This study aims to describe and compare three surgical techniques for mandibular ramus augmentation in hemifacial microsomia and to develop a surgical treatment algorithm based on individual anatomical characteristics and clinical complexity. Materials and Methods: From 2010 to 2022, eighteen patients with Pruzansky–Kaban grade I–IIb hypoplasia underwent staged orthodontic–surgical treatment at our institutions. The standard protocol included initial ramus vertical augmentation followed by bimaxillary osteotomy for asymmetry correction. The patients were equally divided into three groups of six patients each, based on the surgical technique employed. Three representative cases were selected to illustrate the evolution of our approach: (1) bidirectional distraction following a full-thickness osteotomy above the lingula; (2) unidirectional distraction applied to a sagittal ramus osteotomy according to Obwegeser; and (3) direct vertical augmentation with rigid fixation after sagittal osteotomy, supported by virtual surgical planning. Results: Vertical ramus augmentation of 15–25 mm was achieved in all cases. The first technique proved effective but technically demanding. The second approach improved vector control and device stability. The third, involving direct vertical augmentation with rigid fixation, simplified the procedure, reduced costs, and maintained bony contact for stable healing. Conclusions: Sagittal ramus osteotomy with direct stabilization represents a promising alternative to traditional distraction in selected patients, combining historical surgical principles with computer-assisted planning to achieve reproducible outcomes. Full article

Background: Treacher Collins Syndrome (TCS) is a rare, congenital craniofacial syndrome. Its most characteristic feature is mandibular and midface hypoplasia. Due to malformations of the facial skeleton, airway abnormalities can also be observed, predisposing individuals to obstructive sleep apnoea (OSA). OSA in TCS may contribute to significant morbidity, including developmental delays, cardiovascular disorders and reduced quality of life. Objectives: This narrative review aims to present the true prevalence of OSA and the treatment options for TCS patients. Additionally, the pathophysiology and diagnostic tools for this condition were briefly outlined. Methods: The literature search included publications from PubMed, Scopus, Web of Science and Cochrane Library. The chosen period of time for these publications was 2000–2024. Results: The results showed that OSA is a serious problem among TCS patients. Although there is no standardised treatment protocol, the primary methods often include mandibular distraction osteogenesis (MDO) and continuous positive airway pressure (CPAP). Approaches such as hypoglossal nerve stimulation (HNS) need further investigation, especially with longitudinal observations. Conclusions: The development of treatment options seems to be promising, suggesting a favourable outlook for standardising the treatment protocols. Full article

The reconstruction of long bone defects after the primary traumatic, secondary infectious, or tumor-related loss of substance continues to represent a surgical challenge. Distraction osteogenesis using segmental transport, vascularized bone transfer, and the induced membrane technique (IMT) are established methods of reconstruction. IMT has become increasingly popular in recent decades due to its practicability, reproducibility, and reliability. At the same time, the original technique has undergone numerous modifications. The results are correspondingly heterogeneous. This article is intended to provide an overview of the current principles and modifications of IMT, outline the causes of failure of the IMT, and introduce the pearl-string technique (PST). The PST developed in our hospital is based on the pearl-string-like arrangement of thermodisinfected, decorticated femoral heads (TDFHs) in combination with a mechanically stable osteosynthetic construct. The TDFHs are biologically activated with either an RIA or autologous iliac crest bone graft. To gain a better understanding of these variations, the surgical technique of both procedures is illustrated step-by-step in this article. Full article

Distraction Osteogenesis (DO) revolutionizes bone lengthening without donor sites, which is crucial in maxillofacial reconstruction (MRA). Manual DO devices are standard, but continuous DO devices promise faster treatments and better outcomes. Current continuous distractors lack ideal MRA due to size, force generation, and power source limitations. This study introduces a passive distractor system for continuous DO in MRA, aiming to bridge existing gaps and provide an ideal solution for human MRA use. It utilizes a miniaturized mechanism powered by a passive energy source, eliminating the need for active power. Advanced manufacturing methods enable the reduction of device size while hydraulic systems ensure controlled and smooth movement. The system includes a proximal bone fixture, movable distractor components, and passive drive means for distraction force application. Results show promising potential to address existing limitations. By utilizing passive energy for continuous force generation, the device size is reduced, and the need for force transition mechanisms is minimized. This innovative system and method offer an ideal treatment environment for MRA in humans. Further research and clinical evaluation are essential to validate its efficacy and safety in clinical practice. Full article

The treatment of defects of the long bones remains one of the biggest challenges in trauma and orthopedic surgery. The treatment path is usually very wearing for the patient, the patient’s environment and the treating physician. The clinical or regional circumstances, the defect etiology and the patient´s condition and mental status define the treatment path chosen by the treating surgeon. Depending on the patient´s demands, the bony reconstruction has to be taken into consideration at a defect size of 2–3 cm, especially in the lower limbs. Below this defect size, acute shortening or bone grafting is usually preferred. A thorough assessment of the patient´s condition including comorbidities in a multidisciplinary manner and her or his personal demands must be taken into consideration. Several techniques are available to restore continuity of the long bone. In general, these techniques can be divided into repair techniques and reconstructive techniques. The aim of the repair techniques is anatomical restoration of the bone with differentiation of the cortex and marrow. Currently, classic, hybrid or all-internal distraction devices are technical options. However, they are all based on distraction osteogenesis. Reconstructive techniques restore long-bone continuity by replacing the defect zone with autologous bone, e.g., with a vascularized bone graft or with the technique described by Masquelet. Allografts for defect reconstruction in long bones might also be described as possible options. Due to limited access to allografts in many countries and the authors’ opinion that allografts result in poorer outcomes, this review focuses on autologous techniques and gives an internationally aligned overview of the current concepts in repair or reconstruction techniques of segmental long-bone defects. Full article

Distraction osteogenesis (DO) is a reconstruction method for repairing bone deficiencies in the oral and maxillofacial area. Manual DO techniques have shown the functionality of the DO method for bone tissue reconstruction. The DO method can improve treatment conditions, as well as the quality of the reconstructed bone, compared with conventional techniques. Recently, continuous DO devices have been proposed to enable an automatic DO process while using a continuous force for moving the bone segment (BS). Animal studies and clinical trials have shown the successful application of continuous distractors in terms of improving DO factors, including rate and rhythm. The continuous DO technique can shorten the treatment time and enhance the quality of the regenerated tissue. However, the developed continuous distractors are yet to be used in human applications. In this study, by combining motor-driven and hydraulic techniques, a hybrid distractor is proposed. The hybrid distractor is capable of generating a continuous distraction force while controlling the position of the BS in a linear vector, with a high positioning accuracy. Results of modelling and experimental study revealed that the proposed hybrid distractor met all required factors for enabling a continuous DO procedure in humans. The proposed distractor is capable of eliminating the drawbacks of exiting techniques in terms of generating and transferring a controlled distraction force to the BS. The wireless control, as well as the small size of the device, makes this device a suitable solution for use in the reconstruction of bone defects in the maxillofacial area in humans. Full article

The application of Distraction Osteogenesis (DO) techniques in the reconstruction of skeletal deficiencies is a relatively new topic in the fields of oral and maxillofacial surgeries. In many reconstruction applications, using DO is the preferred technique, as opposed to conventional reconstruction techniques, as there are more advantages and fewer side effects when it is used. The first generation of DO devices is made up of manual distractors that can apply an intermittent distraction force to the bone segment during the distraction process. Manual DO techniques have shown the functionality of the DO technique. Further research has recently been performed on the development of automatic devices for generating a controlled continuous force. However, the existing automatic techniques have limitations, and are yet to be used in reconstruction applications in humans. There is still a gap between the developed techniques and an ideal distractor to be used in mandibular reconstruction surgeries. In this research, a two-axis continuous distractor is proposed for use in mandibular reconstruction applications. The proposed distractor can generate two continuous distraction forces that can be applied to two independent distraction vectors. The proposed device can perform the standard distraction process using the predetermined distraction factors. The control system has a high positioning accuracy and resolution in controlling the position of the intra-oral end effectors while applying two continuous forces for moving the bone segment. The proposed two-axis continuous distractor meets the current requirements, and can be used as an ideal continuous DO device for different mandibular reconstruction applications. Full article

External fixators are widely used in deformity correction based on distraction osteogenesis. Traditionally, the rods are manually operated by patients several times a day, which will ensure the patient’s compliance, accumulative adjustment error, and trajectory deviation. To reduce the patients’ compliance and the complexity of adjustment, an electromotor-driven parallel external fixator is developed to gradually correct the deformity, which allows the fixator to be automatically adjusted and can correct any three-dimensional deformity with continuous stability. Two adjustment strategies are proposed through different trajectory control methods based on the inverse kinematics solution, and the trajectory and bone shape are generated to investigate the characteristics of the new bone more intuitively. The range of motion is performed utilizing the numerical searching method to assess the fixator’s correction capability. Finally, the trajectory verification experiment is carried out using the artificial bone model to perform the two adjustment strategies. The results show that the developed external fixator has high correction accuracy with 0.0172 mm, and can accurately and safely realize the preset correction trajectory. The developed fixator system can also be used as a teaching tool for medical training for clinicians to learn deformity correction technology. Full article

The goal of transport-disc-distraction osteogenesis (TDDO) is to restore bone continuity by using in-situ bone. It may be useful following trauma, gunshot injuries, or tumor ablation, especially when there may be contraindications at the donor site or for prolonged surgery. To the best of the authors’ knowledge, this is the first time TDDO has been used for mandibular reconstruction reporting additional procedures, which include osseointegrated dental implants rehabilitation and orthognathic surgery. A retrospective study is performed analyzing all mandibular reconstruction cases that may be suitable for distraction from January 2006 to December 2011. A thorough description of the documented cases includes details about sex, gender, complications, duration of hospitalization, etiology, size, and location of the defect. Eight cases of mandibular reconstruction were included. Six cases correspond to mandibular ameloblastoma. The remaining two cases were mandibular gunshot comminuted fractures. Range of the defects was from 45 to 60 mm. Length of the transport disc was 15 to 20 mm. Protocolized technique consisted of 5 days of latency period, 19 to 45 days of activation term (average 30 days), and 8 to 12 weeks for consolidation. Mean distraction length achieved was 40.45 mm. We can conclude that TDDO is an alternative to conventional and more invasive procedures, when we face severe segmental mandibular defects reconstruction. It shows the potential to restore a better anatomical bone regeneration, also providing soft tissues and reducing donor-site morbidity. Patients’ education and awareness about the proper use of the transport-disc-distraction device is important to optimize functional outcomes. Full article