CRANIOFACIAL
DISTRACTION OSTEOGENESIS
Mikhail Samchukov, Jason
Cope, Alexander Cherkashin
108 contributors, 672 pages, over 1300 illustrations, Mosby
2001
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About
the Authors
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Oppenheimer, the American physicist deeply involved in perfecting the atomic bomb, said in a December, 1994 speech: “Every new finding is a part of the instrument kit of the sciences for further investigation and for penetrating into new fields. Discoveries of knowledge fructify technology and the practical arts, and these in turn pay back refined techniques, new possibilities for observation and experiment.” 1
Interestingly, these words were said in the same year, in which Ilizarov published his starting work “A new principle of osteosynthesis with the use of crossing pins and rings.” 2 In his perhaps serendipitous findings, he discovered that while trying to compress a slow healing lower extremity fracture, the bone segments were inadequately distracted and new bone filled the gap between the two segments. Further work of Ilizarov, using the distraction technique for other long bone fractures, confirmed the soundness of the technique and lead to his seminal report.
Those of us who have worked for years about the craniofacial skeleton have been witness to the gaps formerly occupied by bone, lost through injury, infection, or tumor removal, rapidly refill with bone. The osteogenic promise of all tissue associated with such gaps has long been appreciated, and it has been a test of conscience to see whether one would place a bone graft in many of these gap before bone spontaneously filled them. What was not comprehended was that many of elements involved in distraction osteogenesis were directly before us and no more than passing heed was given to the phenomenon. Fortunately, Ilizarov recognized the marvel of the occurrence in his patient and wisely converted it to practical clinical use.
Even though knowledge of Ilizarov’s work took almost 20 years before reaching the English speaking world around 1973, attraction to the possibilities and use of the technique were quickly recognized. Oppenheimer’s words were prepared for a different audience in 1954, but they could just as easy have been created or those who would be inspired by Ilizarov’s findings which did “penetrate into new fields” about the body. Correction of craniofacial deformities is a highly refined art where modifications and approaches to the craft are constantly being made. The application of the distraction process for repair of complex craniofacial deformities seemed promising and many clinicians and scientists slowly began assessing the biologic response to the mechanics involved in the process. Because the geometry in growth, development, and ultimate configuration of these bones in considerably more divergent than in the long bones with which Ilizarov worked, different mechanical devices were required to distract craniofacial bones. Again, Oppenheimer’s words are apropos because “refined technique, new possibilities for observation and experiment” were necessary to determine the extraordinary potentials inherent in the new knowledge introduced by Ilizarov.
It is bewildering that in the past so much meaning and significance have been given to the single result of a surgical procedure. A broken bone heals, osteotomy and jaw advancement corrects its shortness, an osteotomy and jaw shift improved and asymmetry, and multiple osteotomies and mid-facial advancement fixed distinctive disfigurements. In every procedure, there are a host of tissue changes that also occur that are often aggravating to a patient – jaw opening is sometimes difficult, sensory loss may occur about the face, animation of the brow or lips may be lost, excessive sweating about an area can occur, teeth may become sore or loss, and others. It is refreshing that much of the emphasis of this book relates to bone distraction and the biologic effects of gentle traction to muscle, nerve, gingiva, the periodontal ligament, the temporomandibular joints, movement of teeth, and the foundation of new bone. This earnest, serious science provides a glimpse of how little we know about many of the things we do. There is satisfaction and joy in seeing that this relatively new distraction process is being given sensible study to provide a firm foundation for its predictable use.
For anyone with even a remote interest in craniofacial distraction osteogenesis, this book is highly informative and provides a grand overview of the origin and evolution of the process. For the determined clinician, the book furnishes up-to-the-moment technical information involving the widest clinical uses of craniofacial distraction, the devices used, how they are correctly oriented and attached, how to manage predicaments during use of the devices, and the complications that might occur with the devices. The indications for use ad the meticulous planning required to produce the greatest effectiveness of the process are carefully disclosed. Of great clinical usefulness are the detailed discussions of mandibular lengthening and widening, mandibular bone transport, alveolar distraction, maxillary, mid-face, and cranial distraction. These explanations are the core of the book ad they will be often used as a constant source of reference for those who have engaged craniofacial distraction in their clinical work.
The most contemporary and respected clinical and research workers in the field of craniofacial distraction osteogenesis are contributors to this masterfully done book, which is destined to become the major reference for this newly developed approach in correction of a multitude of craniofacial abnormalities.
REFERENCES
1.
Oppenheimer JR: Prospects in the arts and sciences. In
Copeland L, Lamm LW, editors: The World's Great Speeches, New York, 1973,
Dover Publications Inc.
2.
Ilizarov GA: A new principles of osteosynthesis with the use
of crossing pins and rings. In Collection of scientific works of the Kurgan
regional scientific medical society, Kurgan, Russia, 1954, pp 145-160,
Kurgan Medical Society.
Tom
M. Graber, DMD, MSD, PhD, MD, DSc, ScD, OdontDr, FRCS
Professor of Orthodontics, UIC College of Dentistry, Chicago, Illinois, USA
Editor-in-Chief, World Journal of Orthodontics
Editor-Emeritus, American Journal of Orthodontics and Dentofacial Orthopedic
If anyone says
that there is nothing new in orthognathic surgery and orthodontics, and that we
are just refining techniques and materia technica, then they should look at the
mercurial changes occurring with the introduction of craniofacial distraction
osteogenesis. What a metamorphosis from conventional sagittal split and Le Fort
I operations in orthognathic surgery and, traditional, slow tooth movement in
orthodontics! If someone had predicted that an obscure Siberian surgical
technique, introduced by Ilizarov in the 1950's, would have such a profound
effect, he would have been laughed off the stage. Our diagnostic procedures have
progressed rapidly. We recognize craniofacial skeletal malrelationships and can
reconstruct actual three-dimensional models via computer. Whether surgery or
dentofacial orthopedics, we know the problems. But both conventional surgical
and orthopedic procedures have their therapeutic limitations and potential
iatrogenic sequelae. This has been the “Achilles heel” for too many
orthognathic surgical procedures
As
we enter this new millennium, this book is a true tour de force, with a
veritable international “who’s
who” of contributing authors, providing exciting answers to problems of the
past and innovative procedures that extend our treatment horizons. The magnum
opus is divided into 12 major parts, with an introduction, an amazing 69
chapters, and an epilogue.
Section
I covers the history of craniofacial distraction osteogenesis from its origin in
dentofacial traction, maxillofacial osteotomies, and skeletal fixation. The
evolution of maxillomandibular distraction techniques and devices is well
described, bringing the reader into the modern era of techniques, which is so
eloquently covered in the remainder of the book. From this well organized
introduction, the implications for both surgery and orthodontics are obvious.
The concept of forming new bone under tensional stress is fully elucidated in
Section II. This section has six chapters by multiple authors on in vivo and in
vitro studies of the biology of distraction osteogenesis. The effect of
mechanical loading on the sub-cellular level, as well as the long-term
histologic evaluation of the newly formed regenerate bone provides the raison
d’etre for craniofacial distraction techniques. In addition, subsequent
procedures, such as moving teeth into or placing implants into regenerate bone
are discussed. The biology of distraction histiogenesis, in Section III, has 5
chapters by a star-studded cast, covering topics with important clinical
ramifications such as the effect of gradual tension on muscles, nerves,
gingival, periodontal, and TMJ structures, the very nature of which reach far
beyond the surgical techniques themselves.
Section
IV outlines the biomechanical considerations of distraction device orientation relative
to the anatomic axis of the mandible, desired direction of distraction, and the
maxillary occlusal plane. The clinical application of these concepts is then
illustrated in the subsequent Section V
on indications and treatment planning. Also included are surgical
considerations, orthodontic management of mandibular distraction, and
radiographic classification of distraction regenerate bone.
With
comprehensive 20 chapters devoted to mandibular lengthening and widening,
Section VI is almost a “stand-alone” book, filled with the latest and most
effective appliances and case reports by well recognized authors. A broad gamut
of topics is covered, including orthodontic indications and preparation,
distraction in children with craniofacial deformities, multi-directional
lengthening and widening using extraoral and intraoral devices, TMJ
consequences, and long-term follow-up studies. A smaller Section VII introduces
the technique of mandibular bone transport with by several case reports.
Section
VIII is another comprehensive section, with 11 chapters under the heading of
alveolar distraction. This innovative approach allows the reconstruction of lost
or deficient alveolar bone in preparation for dentoalveolar implant placement
and prosthetic rehabilitation. Many different surgical procedures and devices
are included, demonstrating the multifaceted therapeutic potential of this
technique.
The
AAO’s award winning research and clinical results by Eric Liou on rapid canine
retraction through distraction of the periodontal ligament are presented in
Section IX. Here he fully describes the technique with clinical cases, and in so
doing, opens a dramatically new approach to extraction cases for orthodontists.
Section X is devoted to maxillary and midface distraction. The 10 chapters cover
all aspects, including experimental studies followed by the clinical use of both
intraoral and extraoral devices in correcting maxillary hypoplasias.
Section
XI would almost certainly appeal to the eminent French surgical pioneer, Paul
Tessier, whose dramatic cranial surgery electrified the world. The 4 chapters on
cranial distraction cover the biologic basis with clinical applications and case
reports, fully illustrating the potential for the osteodistraction techniques in
membranous bone. Finally, Section XII is a logical conclusion for this well
designed text – potential complications. It is a straightforward discussion
that is sufficiently covered in two chapters.
The extensive bibliographies and epilogue provide fertile ground for further
reading and encouragement for the reader to make the big step into this exciting
new technique that significantly extends our therapeutic horizons. In short,
this reference is a must for any clinician or scientist exploring the
application of craniofacial distraction osteogenesis.
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