90-173-02-08 04 10 Distraktionsuebersicht, Dystrakcje

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Distraction Osteogenesis
Distraction Devices Overview
Sophisticated Products in OMF Surgery
The lengthening of bones by gradual distraction has
been executed systematically and described for the
first time by the Russian surgeon Prof. Gavril Ilizarov
(Ilizarov 1975, Ilizarov 1988). The principle is to stretch
callus formed after a osteotomy at a rate of 1 mm per
day. This stimulus activates the forces of spontaneous
healing of the bone, so that continuously new callus
is produced and the bone is lengthened.
The smaller the single distraction steps are, the stronger
is the effect of triggering callus formation. Continuous
stretching will bring an optimum stimulation. Besides the
formation of new bone, the simultaneous stretching and
augmentation of the surrounding soft tissue (histogenesis)
is an important advantage of this method. Furthermore,
the low speed of the displacement process allows for better
adaptationofthesofttissues(muscles,existingscars),which
is considered as favorable because it prevents recurrence.
INNOVATION:
Distraction Osteogenesis
Distraction in oral
and cranio-maxillofacial surgery
Since the end of the eighties, the lengthening of bone with the
help of distraction osteogenesis has been used in oral and cranio-
maxillofacial surgery and has become an important option for the
treatment of a certain number of anomalies.
These include mainly syndromatic diseases, like hemifacial
microsomia, severe cleft cases, but also Crouzon or Apert syn-
drome. Besides this, the treatment of bone defects after trauma
is often only possible by distraction of the respective bone struc-
tures. During the past years, consequent miniaturization of the
distraction devices has made it possible to use distraction osteo-
genesis also for the rebuilding of the alveolar ridge in cases of
mandibular atrophy.
KLS Martin Group is considered a world technology leader
in designing and manufacturing clinically approved distraction
devices providing the most complete product range for any
of these indications. Scientific evidence of their use has been
shown in numerous publications quoting said distractors as
ideal tools for the surgeon’s daily work and for the patient’s
benefit.
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INNOVATION:
Distraction Osteogenesis
Advantages
of the technique
Compared to the conventional methods of treatment, distraction offers the
following advantages:
No bone transplantation with the difficult resection of the bone graft.
Minimal risk of infection because vital bone is distracted.
Not only the bone but also the soft tissue is distracted, so that the new bone
is permanently stabilized.
The results of the distraction can be reproduced.
Simple surgical procedure which does not essentially differ from standard
osteosynthesis techniques used in OMF surgery.
Summary
The current spectrum of distraction devices indicates the wide array of
different indications of this technique in oral and craniomaxillofacial surgery.
And yet the future years will bring many new devices such as internal
multidirectional distractors as well as miniaturized systems that can be fixed
by outpatient treatment. The functional and aesthetic advantages for the
patient are obvious.
Indications/Contraindications
Details concerning indications/contraindications, fixation of the distractors
depending on the individual situation etc. can be found in the instructions
for use of the corresponding distractor.
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Exampleofanoperativeapproach:
The surgical procedure is divided into
the following steps, independent of the
selected distraction system:
Adaptation of the distractor to the bone
and the required distraction vector and
marking of the position by pre-drilling of
at least two screw holes on each side of
the osteotomy line.
Removal of the distractor and osteotomy.
It is recommended to separate the
bone completely.
Final fixation of the distractor with
cortical screws and intraoperative test
of the function of the distractor.
Exposing of the bone to be distracted,
if possible by intraoral approach with
vestibular incision.
Closing of the wound and starting of the
distraction after a latency period of 3 to
7 days.
Timetableofadistraction:
Osteotomy
Latencyperiod(3-7days)
Distraction(
1mmperday)
Consolidationperiod(mineralization)
(6-10weeks)
Removalof thedistractor
Subsequenttreatment,remodelling
(prosthetictreatment)
The general rules and guidelines of
Distraction Osteogenesis have to be followed
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90-173-02-08 04 10 Distraktionsuebersicht, Dystrakcje

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