Distraction Osteogenesis

A process used in orthopedic surgery, podiatric surgery, and oral and maxillofacial surgery to repair skeletal deformities

Many patients who are born with craniofacial malformations have the potential for airway compromise related to the underdevelopment of the facial bone framework (Micrognathia).  The soft tissues of the face and airway are suspended by the bones in the face and the jaws.  A lack of appropriate bone growth in the face and jaws can lead to a number of developmental issues including the inability of a child to maintain an open airway during wake and sleep (called sleep apnea), a malformation in how the upper and lower teeth can function against one another (malocclusion) leading to chewing and speech deficiencies and possible malnutrition.  In order to maintain an open airway, in particular while asleep, children both with receded upper and lower jaws (micrognathia) may require the insertion of a surgical airway (known as a tracheostomy).  A procedure knows as Distraction Osteogenesis (DO) allows the surgeons to slowly advance the upper and/or lower jaws to allow opening of the airway and improvement of how the upper and lower jaws function against one another.

An example is demonstrated with a patient born with Pierre Robin Sequence Deformity.  This child was born with a severe under-projection of the lower jaw (micrognathia) which lead to an inability of the child to maintain an open airway.  Faced with the choice of insertion of a tracheostomy, this patient underwent lower jaw distraction osteogenesis as a newborn which allowed the appropriate projection of the lower jaw and avoided the necessity of a surgical airway.

A similar procedure can be carried out on the upper jaw if necessary and can also be conducted at an older age if necessary, to improve various functional deficits.  The below patient, born with a deformity known as Goldenhar’s Syndrome (also known as bilateral Hemi-Facial Microsomia), who underwent the placement of a surgical airway in infancy.  As an older child, he was able to undergo lower jaw advancement distraction osteogenesis which allowed for significant improvement in his airway and ultimately will lead to the ability to remove his tracheostomy.  Notice the position of his chin in the initial photo on the left and the final on the right.

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