Clinical Briefing: Distraction Osteogenesis
November/December 2008
Oral and maxillofacial surgeons at
Penn were among
the first to apply distraction osteogenesis to the
treatment of surgical, genetic, age-related and
traumatic defects of the jaws.1 Originally developed to treat
patients with orthopaedic trauma or disease, distraction
osteogenesis involves the use of a distraction device to
gradually (1 mm per day) separate existing bone segments,
creating gaps where new bone forms.
This process continues
until the desired bone height or length is achieved, at which
point a final consolidation, or healing, phase occurs. During
this time, the immature osteoid matrix matures into bone.
One advantage of distraction osteogenesis is that it
precludes harvest bone grafting, a procedure with many
potential complications.
At Penn, distraction osteogenesis is used to produce
bone growth in a wide range of conditions including
alveolar atrophy of edentulous areas requiring endosseous
implant-supported dental restoration; reconstruction
following segmental resection of the jaw; alveolar defects
due to traumatic injury and congenital alveolar deformity.
1. Havlik RJ, Bartlett SP. J Craniofac Surg. 1994;5:305-310.
Case Study
RW was referred to Penn Oral and Maxillofacial
Surgery at age 13, when a lump was discovered in his left
jaw. On examination, RW was noted to have a painless
expansion of the left buccal cortex of the mandible and
decreased light touch sensation of the left lower lip.
Panorex and CT evaluation revealed a radiolucent lesion
of the left mandible extending from the first premolar
to the angle of the mandible. Histologic examination of
an incisional biopsy of the lesion was consistent with
desmoplastic fibroma. Rather than surgical management
of the lesion, RW and his family opted for a course of
chemotherapy at this time.
When the lesion began to enlarge a year later despite
this treatment, RW had a mandibular resection with
free fibular bone graft reconstruction (Fig 1), a treatment
judged successful. A year later, the neomandible was
evaluated for possible dental rehabilitation. Because RW’s
ridge height would not support endosseous implants and
his bone graft was poorly positioned in relation to the
adjacent dentition, augmentation of the neomandible was
deemed necessary. RW had distraction osteogenesis to
improve his alveolar height.
Following removal of the
reconstruction bone plate, the fibula graft was osteotomized
to create a mobile segment at the superior aspect.
Two alveolar distraction devices were then placed in
parallel (Fig 2).
Five days later, RW began activating the distraction
devices at a rate of 1mm per day. After the device maximum
of 1.5cm was achieved (Fig 3), RW entered the three-to-four
month consolidation phase, then returned for removal of
the distractors. Examination at this time revealed adequate
height of bone to support dental implants. Subsequently,
RW underwent placement of eight dental implants (Fig 4)
followed by fabrication of an implant-supported dental
restoration. His appearance restored, RW has returned to
school and has had no complications.
On-site cytologic analysis demonstrated lymphocytes without
lung cancer in the subcarinal lymph node, but did demonstrate
lung cancer in his right paratracheal lymph node. With
the diagnosis of advanced regional lung cancer, the patient
was not deemed a surgical candidate and was begun on concurrent
definitive chemoradiotherapy. The patient has had a very
good response to aggressive therapy.
Our Team of Faculty
The Department of Oral and Maxillofacial Surgery at
Penn is composed of a multidisciplinary team of dental/
medical specialists whose expertise encompasses non-surgical
and surgical treatment of oral and maxillofacial disorders,
traumatic injuries, congenital defects, oral lesions and
temporomandibular joint dysfunction.
Lawrence M. Levin, DMD, MD
Chair, Department of Oral and Maxillofacial Surgery
Lee
R. Carrasco, DDS, MD
Assistant Professor of Oral and Maxillofacial Surgery
Joli
Chou, DMD, MD
Instructor, Oral and Maxillofacial Surgery
Joseph W. Foote,
DMD, MD
Clinical Associate Professor of Oral and
Maxillofacial Surgery
Helen Giannakopoulos, DDS, MD
Assistant Professor of Oral and Maxillofacial Surgery
Barry
H. Hendler, DDS, MD
Associate Professor of Oral and Maxillofacial Surgery
Peter
Quinn, DMD, MD
Professor of Oral and Maxillofacial Surgery and
Pharmacology-Clinician Educator
David C. Stanton, DMD, MD
Associate Professor of Oral and Maxillofacial Surgery
Locations
Patient appointments are available at:
Department of Oral and Maxillofacial Surgery
Hospital of the University of Pennsylvania
5 White
3400 Spruce Street
Philadelphia, PA 19104
Penn Presbyterian Medical Center
38th and Market Streets
235 Myrin Pavilion
Philadelphia, PA 19104
Penn Medicine at Radnor
250 King of Prussia Road
Radnor, PA 19087
To refer a patient and/or consult
with a doctor, call 800-789-PENN (7366)
or refer
a patient online.
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