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Distraction Osteogenesis

Distraction osteogenesis is a technique in orthognathic surgery used to expand or stretch bone in the jaw.

Bone is a very dynamic tissue in which minerals are constantly added and removed. Doctors and scientists have found that bone mass decreases when it is compressed, and increases when it is stretched.

Distraction osteogenesis involves inducing new bone formation by applying traction (pulling pressure) to the bone in a controlled manner. The technique is based on an orthopedic procedure originally used to lengthen the bones in the leg. It is most often conducted in the mandible (lower jaw) but can also be used in the maxilla (upper jaw). Because soft tissue (such as the surrounding gums) is left attached to the bone, both the soft tissue and the bone are able to expand as necessary. Distraction osteogenesis can be done safely in both children and adults.

Distraction osteogenesis is used to correct badly healed fractures. It is also used in combination with other orthognathic procedures (such as osteotomy, or bone cut) to correct dentofacial deformities caused by congenital or developmental factors, or by trauma or diseases such as cancer.

Treatment

Distraction osteogenesis is done in several stages. In the first stage, a special mechanical device called a distraction device is surgically inserted into a specific position into the patient's jaw. During this surgery, any needed osteotomy (bone-cut) is also done. A short hospital stay is usually required after the surgery to make sure that no infection develops around the distraction device.

Some distraction devices are external, meaning they sit visibly on the outside of the face. Others are internal, meaning that except for the rod used to tighten the mechanisms they are mostly buried under soft tissue.

After a short waiting period to recover from the surgery, patients are instructed on how to use the device (devices generally have a small screw, which is turned to apply distraction), and on how much distraction they should apply each day. Frequent visits to the surgeon are required to watch for any complications and to make sure the distraction is occurring as planned.

After the bone has been expanded as necessary, the distraction device is left in place for another 60 to 90 days and acts to fix the position of the newly formed bone. The device can be removed after this fixation period. Depending on what kind of device was used, removal may also require a surgical procedure.

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