min. read
Distraction osteogenesis is a powerful way to make bone grow after surgery. We used distraction osteogenesis to make bones longer, such as to treat babies born with small lower jaws that interfere with them breathing, or to move a bone from one place to another, such as in Le Fort 3 midface advancement (link to LF 3 section) when the entire upper face has not grown properly. Distraction osteogenesis allows for bigger corrections in bone position than is possible in a single traditional surgery. This improves the results and may reduce the amount of surgery a child needs over their lifetime. Very few centers around the world have as much experience with distraction osteogenesis as our team in North Austin.
Along with your surgeon, our craniofacial orthodontist will be closely involved in planning the surgery and following your child with the surgeon after surgery.
In traditional surgery, a surgeon uses bone grafts taken from another part of the body to lengthen bones, and metal plates and screws to move a bone into a new position. Grafts and plates are no longer needed with distraction osteogenesis,. The surgeon instead only makes a cut in the bone (“osteotomy”) and then attaches a device called a distractor to the cut bone. Sometimes the surgeon places the distractor under the skin (“internal distractor”). Other times they will attach them to a child’s skull or face bones on the outside of their skin using small metal pins that attach to the bone through the skin (“external distractor”).
After the surgery to make the cut in the bone and to apply the distractor, there are three phases of distraction osteogenesis:
The latency phase follows the surgery and last 2 to 5 days. Your child’s condition and age will determine how long. During this phase, a special tissue starts to grow between the gap in the bone cut called “generate”. This “generate” is made up of special cells from your child’s bone that can slowly be stretched, like taffy, and then later become bone.
The activation phase follows the latency phase. Once the “generate” starts to form, it must be stretched by the distractors or else the cut in the bone will heal too quickly. Out team will teach you how to “activate” or turn the distractors twice day after your child leaves the hospital. Parents soon become comfortable with turning the devices. The turning will open the gap in the bone and stretch the “generate” at a very slow rate of 1 to 2 millimeters (around 1/16th of an inch) each day. Older children say that the turning of the distractors does not hurt, but towards the end of the activation phase can feel like the ache that patients feel after they have their orthodontic braces adjusted.
The activation phase can last 2-4 weeks depending on the distance the bone needs to move or get longer. During the activation phase you will need to bring your child to clinic to see the team once a week.
Once the activation phase is finished the distractors have stretched the “generate” and the bone now has the correct position or length. Your child then starts the consolidation or healing phase. The distractors are no longer turned, and the resting “generate” starts to become solid bone. This phase can last two to three months - similar to the time a child would wear a cast for a broken arm. During the consolidation phase the distractor devices stay in place, similar to a cast, to protect the healing “generate”. Your child feels stronger during the healing phase and will want to return to their normal activities. However, it is important to protect the healing bone during this phase by avoiding sports, balls and contact activities. Once the consolidation phase is over, we will arrange for a final surgery to remove the distractors. External distractors are easier and quicker to remove than internal (buried) distractors.
Distraction osteogenesis is an option for many surgeries that move bones in the skull and face into better positions. Our team works together and with you to decide if the best result requires distraction osteogenesis.
Surgeons in our Craniofacial program use distraction osteogenesis in these procedures:
- Posterior cranial vault distraction to give the brain room to grow after craniosynostosis
- Monobloc frontofacial advancement for complex craniofacial syndromes
- Segmental subcranial distraction to normalize the proportions of the face (LF2ZR)
- Subcranial rotation distraction to improve the airway and jaw position (C3DO)
- Le Fort I maxillary advancement to correct upper jaws that have not grown properly
- Le Fort 3 midface advancement to move the middle of the face forward
- Mandible distraction for a lower jaw has not formed properly
76046
Conditions
article