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Jejurikar N, Herrero C, Fabbri N. The Role of Distraction Osteogenesis in Limb Salvage for Tumors. Bull Hosp Jt Dis (2013) 2024; 82:39-42. [PMID: 38431976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Modern technology and advances in medicine have facilitated increasing rates of limb salvage in the treatment of sarcomas. Orthopedic oncologists have a wide array of reconstruction options for limb salvage, ranging from allografts to endoprosthesis reconstruction. Limb lengthening is another option available to an orthopedic oncologist faced with bony defects and limb length discrepancies following resection. This review provides a brief history of limb lengthening, the principles of distraction osteogenesis, and current applications in orthopedic oncology. Considering the complications and challenges associated with the lengthening process, appropriate patient selection and thorough patient counseling is key to optimizing outcomes.
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Vogt B, Laufer A, Gosheger G, Toporowski G, Antfang C, Rölfing JD, Rödl R, Frommer A. Evaluation of simultaneous bilateral femoral distraction osteogenesis with antegrade intramedullary lengthening nails in achondroplasia with rhizomelic short stature: a retrospective study of 15 patients with a minimum follow-up of 2 years. Acta Orthop 2024; 95:47-54. [PMID: 38287909 PMCID: PMC10825798 DOI: 10.2340/17453674.2024.35226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 11/07/2023] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND AND PURPOSE Bilateral femoral distraction osteogenesis in patients with achondroplasia is insufficiently reported. We aimed to perform the first study that exclusively analyzed simultaneous bilateral femoral distraction osteogenesis with motorized intramedullary lengthening nails via an antegrade approach in patients with achondroplasia focused on reliability, accuracy, precision, and the evolving complications. PATIENTS AND METHODS In this retrospective singlecenter study we analyzed patients with achondroplasia who underwent simultaneous bilateral femoral lengthening with antegrade intramedullary lengthening nails between October 2014 and April 2019. 15 patients (30 femoral segments) of median age 14 years (interquartile range [IQR] 12-15) were available for analysis. The median follow-up was 29 months (IQR 27-37) after nail implantation. RESULTS The median distraction length per segment was 49 mm (IQR 47-51) with a median distraction index of 1.0 mm/day (IQR 0.9-1.0), and a median consolidation index of 20 days/cm (IQR 17-23). Reliability of the lengthening nails was 97% and their calculated accuracy and precision were 96% and 95%, respectively. The most common complication was temporary restriction of knee range of motion during distraction in 10 of 30 of the lengthened segments. 1 patient was treated with 2 unplanned additional surgeries due to premature consolidation. CONCLUSION The method is reliable and accurate with few complications.
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Affiliation(s)
- Björn Vogt
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, Muenster, Germany; General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany.
| | - Andrea Laufer
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, Muenster, Germany; General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Georg Gosheger
- General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Gregor Toporowski
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, Muenster, Germany; General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Carina Antfang
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, Muenster, Germany; General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Jan Duedal Rölfing
- Children's Orthopedics and Reconstruction, Aarhus University Hospital, Aarhus, Denmark
| | - Robert Rödl
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, Muenster, Germany; General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Adrien Frommer
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, Muenster, Germany; General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
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Liu X, Zhang Z, Han W, Zhao Z, Kim BS, Yan Y, Chen X, Wang X, Li X, Yang X, Wang B, Xu H, Lin L, Chai G. Efficacy of navigation system-assisted distraction osteogenesis for hemifacial microsomia based on artificial intelligence for 3 to 18 years old: study protocol for a randomized controlled single-blind trial. Trials 2024; 25:42. [PMID: 38216974 PMCID: PMC10785481 DOI: 10.1186/s13063-023-07809-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 11/20/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Mandibular distraction osteogenesis (MDO) is a major part of the treatment for hemifacial microsomia patients. Due to the narrow surgical field of the intraoral approach, osteotomy accuracy is highly dependent on the surgeons' experience. Electromagnetic (EM) tracking systems can achieve satisfying accuracy to provide helpful real-time surgical navigation. Our research team developed an EM navigation system based on artificial intelligence, which has been justified in improving the accuracy of osteotomy in the MDO in animal experiments. This study aims to clarify the effect of the EM navigation system in improving the MDO accuracy for hemifacial microsomia patients. METHODS This study is designed as a single-centered and randomized controlled trial. Altogether, 22 hemifacial microsomia patients are randomly assigned to the experiment and control groups. All patients receive three-dimensional CT scans and preoperative surgical plans. The EM navigation system will be set up for those in the experiment group, and the control group will undergo traditional surgery. The primary outcome is the surgical precision by comparing the osteotomy position of pre- and postoperative CT scan images through the Geomagic Control software. The secondary outcomes include mandibular symmetry (occlusal plane deviation angle, mandibular ramus height, and body length), pain scale, and complications. Other indications, such as the adverse events of the system and the satisfactory score from patients and their families, will be recorded. DISCUSSION This small sample randomized controlled trial intends to explore the application of an EM navigation system in MDO for patients, which has been adopted in other surgeries such as orthognathic procedures. Because of the delicate structures of children and the narrow surgical view, accurate osteotomy and protection of nearby tissue from injury are essential for successful treatment. The EM navigation system based on artificial intelligence adopted in this trial is hypothesized to provide precise real-time navigation for surgeons and optimally improve patient outcomes, including function and aesthetic results. The results of this trial will extend the application of new navigation technology in pediatric plastic surgery. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2200061565. Registered on 29 June 2022.
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Affiliation(s)
- Xiangqi Liu
- Department of Plastic and Reconstructive Surgery, Shanghai 9Th People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhi Zao Ju Rd., Shanghai, 200011, China
| | - Ziwei Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai 9Th People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhi Zao Ju Rd., Shanghai, 200011, China
| | - Wenqing Han
- Department of Plastic and Reconstructive Surgery, Shanghai 9Th People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhi Zao Ju Rd., Shanghai, 200011, China
| | - Zhijie Zhao
- Department of Plastic and Reconstructive Surgery, Shanghai 9Th People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhi Zao Ju Rd., Shanghai, 200011, China
| | - Byeong Seop Kim
- Department of Plastic and Reconstructive Surgery, Shanghai 9Th People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhi Zao Ju Rd., Shanghai, 200011, China
| | - Yingjie Yan
- Department of Plastic and Reconstructive Surgery, Shanghai 9Th People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhi Zao Ju Rd., Shanghai, 200011, China
| | - Xiaojun Chen
- Department of Plastic and Reconstructive Surgery, Shanghai 9Th People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhi Zao Ju Rd., Shanghai, 200011, China
| | - Xuetong Wang
- Department of Plastic and Reconstructive Surgery, Shanghai 9Th People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhi Zao Ju Rd., Shanghai, 200011, China
| | - Xin Li
- Department of Plastic and Reconstructive Surgery, Shanghai 9Th People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhi Zao Ju Rd., Shanghai, 200011, China
| | - Xianxian Yang
- Department of Plastic and Reconstructive Surgery, Shanghai 9Th People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhi Zao Ju Rd., Shanghai, 200011, China
| | - Bingshun Wang
- Department of Biostatistics, Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, 227 Chong Qing Nan Rd., Shanghai, 200025, China
| | - Haisong Xu
- Department of Plastic and Reconstructive Surgery, Shanghai 9Th People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhi Zao Ju Rd., Shanghai, 200011, China
| | - Li Lin
- Department of Plastic and Reconstructive Surgery, Shanghai 9Th People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhi Zao Ju Rd., Shanghai, 200011, China.
| | - Gang Chai
- Department of Plastic and Reconstructive Surgery, Shanghai 9Th People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhi Zao Ju Rd., Shanghai, 200011, China.
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Pesis M, Goldbart A, Givol N. Surgical correction of neonatal obstructive sleep apnea due to a temporomandibular joint ankylosis. J Clin Sleep Med 2024; 20:173-179. [PMID: 37811905 PMCID: PMC10758565 DOI: 10.5664/jcsm.10856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 09/30/2023] [Accepted: 10/05/2023] [Indexed: 10/10/2023]
Abstract
In growing children, temporomandibular joint (TMJ) ankylosis and septic arthritis are uncommon. Retrognathia and micrognathia affect airway patency and can cause obstructive sleep apnea (OSA). No unified diagnostic criteria have been established for the management of this pathology. We describe the first case of treatment for pediatric TMJ ankylosis and severe OSA due to neonatal group B streptococcal septic TMJ arthritis. Untreated pathological changes in the TMJ will eventually lead to ankylosis. Among children, this will include facial growth disturbances leading to mandibular retrognathia, reduction in the oropharyngeal spaces, and OSA. Our patient had severe OSA with an apnea-hypopnea index of 24.9 events/h and oxygen saturation nadir of 73% as measured by polysomnography. She was treated successfully according to Andrade protocol. This is the first report of pediatric OSA due to TMJ ankylosis following neonatal group B streptococcal septic arthritis. CITATION Pesis M, Goldbart A, Givol N. Surgical correction of neonatal obstructive sleep apnea due to a temporomandibular joint ankylosis. J Clin Sleep Med. 2024;20(1):173-179.
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Affiliation(s)
- Michael Pesis
- Oral and Maxillofacial Surgery Unit, Soroka University Medical Center, Beer Sheva, Israel
- Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Aviv Goldbart
- Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
- Department of Pediatrics, Saban Pediatric Medical Center, Soroka University Medical Center, Beer Sheva, Israel
| | - Navot Givol
- Oral and Maxillofacial Surgery Unit, Soroka University Medical Center, Beer Sheva, Israel
- Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Shu KY, Liu W, Zhao JL, Zhang ZY, Shan BG, Li XY, Ma LK. Condylar resorption post mandibular distraction osteogenesis in craniofacial microsomia: A retrospective study. J Craniomaxillofac Surg 2023; 51:675-681. [PMID: 37852887 DOI: 10.1016/j.jcms.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 09/12/2023] [Accepted: 10/05/2023] [Indexed: 10/20/2023] Open
Abstract
The aim of this study was to investigate the characteristics of condylar resorption in craniofacial microsomia (CFM) patients following mandibular distraction osteogenesis (MDO). Patients with unilateral type-IIa and type-IIb CFM, who had completed MDO and mandibular distractor extraction (MDE), were recruited. The height and volume of the condyle were measured on three-dimension models created by the analysis of computed tomography (CT) data. Normality analysis was performed using the Shapiro-Wilk test. Data for the affected and unaffected sides were compared using the paired t-test or Wilcoxon signed-rank test. Data for both type-IIa and type-IIb CFM were compared using the independent-samples t-test or Mann-Whitney U test. The Pearson or Spearman correlation was used to determine the correlations of condylar resorption rate with related measurements. In total, 48 type-IIa and 48 type-IIb CFM patients were included. The condylar resorption rate in type-IIa CFM (0.35 ± 0.32) was significantly associated with the height of the condyle (r = 0.776, p < 0.001) and distraction distance (r = 0.447, p = 0.001), while the condylar resorption rate in type-IIb CFM (0.49 ± 0.46) was significantly associated with the height of the condyle (r = 0.924, p < 0.001). However, there was no significant difference in condylar resorption rate between type-IIa and type-IIb CFM (p = 0.075). In addition to occlusal changes, no other negative symptoms of the TMJ were observed with condylar resorption. Condylar resorption was evident in CFM patients following mandibular distraction osteogenesis, and the condylar resorption rate showed a relationship with distraction distance and condylar height.
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Affiliation(s)
- Kai-Yi Shu
- Department of Medical Cosmetology and Plastic Surgery, The Third People's Hospital of Chengdu, Chengdu, China
| | - Wei Liu
- Department of Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiu-Li Zhao
- Department of Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhi-Yong Zhang
- Department of Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Ba-Ga Shan
- Department of Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xi-Yuan Li
- Department of Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lun-Kun Ma
- Department of Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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La-Anyane OM, Whitney NB, Harmon KA, Karas AF, Jeffe JS, Tragos C. Tracheostomy, the Not So Definitive Airway?: Tracheostomy Morbidity in Pediatric Craniofacial Patients. J Craniofac Surg 2023; 34:2413-2416. [PMID: 37639682 DOI: 10.1097/scs.0000000000009627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/03/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Tracheostomy is the definitive treatment for airway management in severe cases of craniofacial-associated upper airway obstruction, like the Pierre-Robin sequence, but is associated with significant morbidity. The purpose of this study was to examine tracheostomy-associated morbidities and mortalities in craniofacial patients to identify opportunities to improve clinical care and patient prognosis. METHODS The study was a retrospective review of pediatric craniofacial patients who were tracheostomized between 2016 and 2022. Data regarding their demographics, craniofacial diagnoses, endoscopic airway anomalies, intubation grade of view classification, tracheostomy-related complications, and causes of mortality were analyzed. RESULTS Sixteen of the 17 tracheostomized pediatric patients had the Pierre-Robin sequence, with 5 of those patients having an additional syndromic craniofacial diagnosis. Additional airway anomalies were found in 82.4% of the patients. The mean length of hospital stay after tracheostomy was 4.08 months. Infection was the most common complication, observed in 94.1% of patients, followed by stomal granulation in 76.5% of patients. Two mortalities were observed: one following the compassionate removal of ventilator support and the other following the accidental dislodgment of the tracheostomy tube. CONCLUSIONS Tracheostomy-related complications were observed in all craniofacial patients in this group. Compared with the general pediatric population, tracheostomized craniofacial patients may endure longer hospital stays and greater stomal granulation rates. Mandibular distraction osteogenesis may allow for tracheostomy avoidance in these patients, and future research should focus on comparing the long-term complication rates and outcomes between tracheostomy mandibular distraction osteogenesis in this challenging patient population.
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Affiliation(s)
- Okensama M La-Anyane
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rush University Medical Center, Chicago, IL
| | - Natalia B Whitney
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rush University Medical Center, Chicago, IL
| | - Kelly A Harmon
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rush University Medical Center, Chicago, IL
| | - Anatoli F Karas
- Department of Otorhinolaryngology, Rush University Medical Center, Chicago, IL
| | - Jill S Jeffe
- Department of Otorhinolaryngology, Rush University Medical Center, Chicago, IL
- Department of Otolaryngology, University of Utah, Primary Children's Hospital, Salt Lake City, UT
| | - Christina Tragos
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rush University Medical Center, Chicago, IL
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Klintö K, Svensson H, Wiedel AP. Long-term speech outcome after anterior distraction osteogenesis of the maxilla in patients with cleft lip and palate. J Plast Surg Hand Surg 2023; 58:110-114. [PMID: 37768144 DOI: 10.2340/jphs.v58.12308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023]
Abstract
Advancement of the maxilla may increase the distance between the soft palate and the posterior pharyngeal wall in patients with cleft lip and palate, implying a risk of velopharyngeal dysfunction. The aim was to evaluate long-term speech outcome in a consecutive series of patients treated with distraction osteogenesis (DO). Fourteen out of the 16 patients agreed to participate. A long-term speech follow-up was performed 1.5 to 13.5 years after DO. For two participants, audio recordings before DO were missing, and for another one, it was incomplete. The percentage of consonants correct (PCC) based on phonetic transcription and perceived velopharyngeal competence rated on a three-point scale were assessed before and after DO by three independent judges, based on audio recordings of reading of standardised sentences. Also, the participants were asked how they perceived their speech after DO. Changes in PCC were insignificant. Four participants perceived deteriorated speech related to DO. In two cases, the subjective deterioration did not correlate to results from perceptual assessment. In two others, the subjective deterioration correlated with the perceptual assessment, and the velopharyngeal function was judged as being incompetent after DO. After secondary velopharyngeal surgery, velopharyngeal function improved to competent in one case and marginally incompetent in the other. The results need to be interpreted with caution due to methodological limitations but indicate that some patients develop deteriorated velopharyngeal function after DO. The impact on articulation needs to be further explored. It is important that patients are informed before treatment of the risk of velopharyngeal dysfunction after DO.
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Affiliation(s)
- Kristina Klintö
- Department of Clinical Sciences in Lund, Lund University, Lund, Sweden; Department of Otorhinolaryngology, Skåne University Hospital, Malmö, Sweden.
| | - Henry Svensson
- Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden; Department of Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden
| | - Anna-Paulina Wiedel
- Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden; Department of Oral and Maxillofacial Surgery, Skåne University Hospital, Malmö, Sweden; Department of Orthodontics, Malmö University, Malmö, Sweden
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Miller EM, Jungbauer WN, Carroll WW, Pecha PP. Delayed Sublingual Edema Following Neonatal Mandibular Distraction Osteogenesis. J Craniofac Surg 2023; 34:e612-e614. [PMID: 37497798 DOI: 10.1097/scs.0000000000009554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 05/28/2023] [Indexed: 07/28/2023] Open
Abstract
The authors aim to report a rare sequela following neonatal mandibular distraction osteogenesis (MDO) involving delayed onset sublingual swelling. They performed a retrospective chart review of 3 patients who presented with delayed onset sublingual edema following neonatal MDO. The 3 patients presented at 2, 4, and 12 months following MDO for micrognathia secondary to Robin sequence with intermittent sublingual swelling associated with sialorrhea and feeding difficulties. There was no associated recent illness, fevers, or purulent drainage. All 3 children underwent magnetic resonance imaging which demonstrated asymmetric sublingual gland edema. The edema was located on the left sublingual gland in 2 children and was bilateral in the third. The symptoms continue to recur 25.5±3.3 months (range, 22.3-28.9) postoperatively and all are being managed conservatively. Chronic delayed onset intermittent sublingual edema is a possible long-term complication following neonatal MDO and further studies should explore the incidence and management of this finding.
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Affiliation(s)
- Emma Marin Miller
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
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Hung WC, Chen CH, Lin CH, Chen TY, Lo SP. Subacute two stage metatarsal lengthening with gradual distraction for brachymetatarsia: A consecutive case series and literature review. Foot Ankle Surg 2023; 29:86-89. [PMID: 36328920 DOI: 10.1016/j.fas.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/30/2022] [Accepted: 10/19/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study examined the functional and clinical outcomes of subacute two stage metatarsal lengthening with gradual distraction for brachymetatarsia. This technique was developed to overcome the disadvantages of one-stage metatarsal lengthening and gradual distraction. METHODS Four feet of three patients with congenital brachymetatarsia underwent subacute two stage metatarsal lengthening with gradual distraction. Pain, function, and alignment were assessed preoperatively and at follow-ups using the American Orthopaedic Foot and Ankle Society (AOFAS) lesser metatarsophalangeal-interphalangeal scale, and any complications were recorded. RESULTS The patients were followed up for a mean of 18.1 ± 6.9 (range, 12.6-28.1) months. The mean metatarsal length gain was 15.2 ± 3.2 (range, 12.1-18.5) mm, and the corresponding percent increase was 32.5 % ± 7.0 % (range, 25.7-41.1 %). The mean AOFAS score (0-100) was 97.5 ± 5.0 at the final follow-up. The external fixator index was 10.2 ± 1.5 (range, 8.1-11.6) days/cm. None of the patients experienced metatarsophalangeal stiffness, subluxation or dislocation of the metatarsophalangeal joint, loss of correction, pin tract infection, delayed union, nonunion, or angular deformities. CONCLUSION Subacute two stage metatarsal lengthening with gradual distraction is a reliable alternative treatment for brachymetatarsia.
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Affiliation(s)
- Wei-Chen Hung
- Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Chun-Ho Chen
- Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Chang-Hao Lin
- Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Tzu-Yin Chen
- Department of Physical Therapy, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Sheng-Pin Lo
- Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan.
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Lu Y, Canavese F, Lin R, Huang Y, Wu X, Lin B, Chen S. Distraction osteogenesis at the proximal third of the ulna for the treatment of Masada type I/IIb deformities in children with hereditary multiple exostoses: a retrospective review of twenty cases. Int Orthop 2022; 46:2877-2885. [PMID: 36087118 DOI: 10.1007/s00264-022-05551-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/11/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND Ulna distraction by monolateral external fixator (MEFix) is a good option for the treatment of Masada type I and IIb deformities in children with hereditary multiple exostoses (HMEs). However, there is no consensus regarding where to perform ulnar osteotomy. Our hypothesis is that osteotomy at the proximal third of the ulna and progressive distraction with MEFix can simultaneously correct elbow and wrist deformities in patients with HME. METHODS We retrospectively reviewed patients with HME who underwent ulna distraction osteogenesis from June 2014 to March 2019. The carrying angle (CA), radial articular angle (RAA), ulnar variance (UV), radial variance (RV) and range of motion (ROM) of the affected forearm and elbow were clinically assessed before lengthening and at the last follow-up visit. The total ulna lengthening distance (LD) and radiographic outcome were also recorded. RESULTS Nineteen patients (20 forearms) with HME aged 9.1 ± 2.4 years at the time of surgery were retrospectively reviewed. The mean follow-up period was 26.1 ± 5.6 months. There were 11 patients (12 forearms) with Masada type I deformities and eight patients (8 forearms) with Masada type IIb deformities. Patients with type IIb deformity had higher RV, lower CA values, less elbow flexion and forearm pronosupination than those with type I deformity (p < 0.05); RV was an independent risk factor for radial head dislocation, with the cut off at RV > 15.5 mm. The mean LDs in patients with type I and type IIb deformities were 33.6 ± 6.6 mm and 41.4 ± 5.4 mm, respectively. The mean CA, UV, RV, forearm pronation and ulna deviation at the wrist improved significantly following surgery in all patients. In particular, five of eight patients (62.5%) with type IIb deformities had concentric reduction of the radiocapitellar joint, while no radial head subluxation was detected in patients with type I deformities at the last follow-up. Three complications were recorded: two pin-track infections and one delayed union. CONCLUSIONS Distraction osteogenesis at the proximal third of the ulna provides satisfactory clinical and radiological outcomes in patients with Masada type I and IIb deformities. Early treatment of Masada type I deformities is indicated before progression to more complex type IIb deformities.
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Affiliation(s)
- Yunan Lu
- Department of Paediatric Orthopaedics, Fuzhou Second Hospital, The Third Clinical Medical College, Fujian Medical University, Fuzhou Second Hospital of Xiamen University, School of Medicine, Xiamen University, 47th Shangteng Road of Cangshan District, Fuzhou, 350007, Fujian Province, China
| | - Federico Canavese
- Department of Paediatric Orthopaedic Surgery, Lille University Centre, Jeanne de Flandre Hospital, Rue Eugène Avinée, 59000, Lille, France
| | - Ran Lin
- Department of Paediatric Orthopaedics, Fuzhou Second Hospital, The Third Clinical Medical College, Fujian Medical University, Fuzhou Second Hospital of Xiamen University, School of Medicine, Xiamen University, 47th Shangteng Road of Cangshan District, Fuzhou, 350007, Fujian Province, China
| | - Yuling Huang
- Department of Paediatric Orthopaedics, Fuzhou Second Hospital, The Third Clinical Medical College, Fujian Medical University, Fuzhou Second Hospital of Xiamen University, School of Medicine, Xiamen University, 47th Shangteng Road of Cangshan District, Fuzhou, 350007, Fujian Province, China
| | - Xinwu Wu
- Department of Paediatric Orthopaedics, Fuzhou Second Hospital, The Third Clinical Medical College, Fujian Medical University, Fuzhou Second Hospital of Xiamen University, School of Medicine, Xiamen University, 47th Shangteng Road of Cangshan District, Fuzhou, 350007, Fujian Province, China
| | - Binbin Lin
- Department of Paediatric Orthopaedics, Fuzhou Second Hospital, The Third Clinical Medical College, Fujian Medical University, Fuzhou Second Hospital of Xiamen University, School of Medicine, Xiamen University, 47th Shangteng Road of Cangshan District, Fuzhou, 350007, Fujian Province, China
| | - Shunyou Chen
- Department of Paediatric Orthopaedics, Fuzhou Second Hospital, The Third Clinical Medical College, Fujian Medical University, Fuzhou Second Hospital of Xiamen University, School of Medicine, Xiamen University, 47th Shangteng Road of Cangshan District, Fuzhou, 350007, Fujian Province, China.
- Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma (2020Y2014), Fuzhou, 350007, China.
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Laufer A, Rölfing JD, Gosheger G, Toporowski G, Frommer A, Roedl R, Vogt B. What Are the Risks and Functional Outcomes Associated With Bilateral Humeral Lengthening Using a Monolateral External Fixator in Patients With Achondroplasia? Clin Orthop Relat Res 2022; 480:1779-1789. [PMID: 35471200 PMCID: PMC9384902 DOI: 10.1097/corr.0000000000002209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 03/22/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Many patients with achondroplasia experience functional impairments because of rhizomelic upper extremities (proximal limb shortening). Bilateral humeral lengthening may overcome these functional limitations, but it is associated with several risks, such as radial nerve palsy and insufficient bone regeneration. Only a few studies have reported on patient satisfaction and functional outcome after humeral lengthening in patients with achondroplasia. Furthermore, the reported numbers of adverse events associated with lengthening procedures using external fixators vary widely. QUESTIONS/PURPOSES (1) Does bilateral humeral lengthening with a monolateral external fixator in patients with achondroplasia reliably improve patient function and autonomy, and what proportion of patients achieved at least 8 cm of humeral lengthening? (2) What adverse events occur after bilateral humeral lengthening with monolateral external fixators? METHODS Between 2011 and 2019, 44 patients underwent humeral lengthening at our institution. Humeral lengthening was performed in patients with severe shortening of the upper extremities and functional impairments. In humeri in which intramedullary devices were not applicable, lengthening was performed with monolateral external fixators in 40 patients. Eight patients were excluded because they underwent unilateral lengthening for etiologies other than achondroplasia, and another four patients did not fulfill the minimum study follow-up period of 2 years, leaving 28 patients with bilateral humeral lengthening to treat achondroplasia available for analysis in this retrospective study. The patients had a median (interquartile range) age of 8 years (8 to 10), and 50% (14 of 28) were girls. The median follow-up time was 6 years (4 to 8). The median humeral lengthening was 9 cm (9 to 10) with a median elongation of 73% (67% to 78%) from an initial median length of 12 cm (11 to 13). To determine whether this treatment reliably improved patient function and autonomy, surgeons retrospectively evaluated patient charts. An unvalidated retrospective patient-reported outcome measure questionnaire consisting of nine items (with answers of "yes" or "no" or a 5-point Likert scale) was administered to assess the patient's functional improvement in activities of daily living, physical appearance, and overall satisfaction, such that 45 points was the highest possible score. The radiographic outcome was assessed on calibrated radiographs of the humerus. To ascertain the proportion of adverse events, study surgeons performed a chart review and telephone interviews. Major complications were defined as events that resulted in unplanned revision surgery, nerve injury (either temporary or permanent), refracture of the bone regenerate, or permanent functional sequelae. Minor complications were characterized as events that resolved without further surgical interventions. RESULTS On our unvalidated assessment of patient function and independence, all patients reported improvement at their most recent follow-up compared with scores obtained before treatment (median [IQR] 24 [16 to 28] before surgery versus 44 [42 to 45] at latest follow-up, difference of medians 20 points, p < 0.001). A total of 89% (25 of 28) of patients achieved the desired 8 cm of lengthening in both arms. A total of 50% (14 of 28) of our patients experienced a major complication. Specifically, 39% (11 of 28) had an unplanned reoperation, 39% (11 of 28) had a radial nerve palsy, 18% (5 of 28) had a refracture of the regenerate, and 4% (1 of 28) concluded treatment with a severe limb length discrepancy. In addition, 82% (23 of 28) of our patients experienced minor complications that resolved without further surgery and did not involve radial nerve symptoms. Radial nerve palsy was observed immediately postoperatively in eight of 13 segments, and 1 to 7 days postoperatively in five of 13 segments. The treatment goal was not achieved because of radial nerve palsy in 5% (3 of 56) of lengthened segments, which occurred in 7% (2 of 28) of patients. Full functional recovery of the radial nerve was observed in all patients after a median (IQR) of 3 months (2 to 5). Refractures of bone regenerates were observed in 11% (6 of 56) of humeri in 18% (5 of 28) of patients. Of those refractures, 1 of 6 patients was treated nonsurgically with a hanging cast, while 5 of 6 patients underwent revision surgery with intramedullary rodding. CONCLUSION Most patients with achondroplasia who underwent humeral lengthening achieved the treatment goal without permanent sequelae; nonetheless, complications of treatment were common, and the road to recovery was long and often complicated, with many patients experiencing problems that were either painful (such as refracture) or bothersome (such as temporary radial nerve palsy). However, using a subjective scale, patients seemed improved after treatment; nevertheless, robust outcomes tools are not available for this condition, and so we must interpret that finding with caution. Considering our discoveries, bilateral humeral lengthening with a monolateral external fixator should only be considered in patients with severe functional impairments because of rhizomelic shortening of the upper extremities. If feasible, internal lengthening devices might be preferable, as these are generally associated with higher patient comfort and decreased complication rates compared with external fixators. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Andrea Laufer
- Pediatric Orthopaedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, Muenster, Germany
| | - Jan Duedal Rölfing
- Pediatric Orthopaedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, Muenster, Germany
- Children’s Orthopaedics and Reconstruction, Aarhus University Hospital, Aarhus, Denmark
| | - Georg Gosheger
- General Orthopaedics and Tumor Orthopaedics, University Hospital Muenster, Muenster, Germany
| | - Gregor Toporowski
- Pediatric Orthopaedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, Muenster, Germany
| | - Adrien Frommer
- Pediatric Orthopaedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, Muenster, Germany
| | - Robert Roedl
- Pediatric Orthopaedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, Muenster, Germany
| | - Bjoern Vogt
- Pediatric Orthopaedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, Muenster, Germany
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Frommer A, Roedl R, Gosheger G, Niemann M, Turkowski D, Toporowski G, Theil C, Laufer A, Vogt B. What Are the Potential Benefits and Risks of Using Magnetically Driven Antegrade Intramedullary Lengthening Nails for Femoral Lengthening to Treat Leg Length Discrepancy? Clin Orthop Relat Res 2022; 480:790-803. [PMID: 34780384 PMCID: PMC8923575 DOI: 10.1097/corr.0000000000002036] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 10/08/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Limb lengthening with magnetically driven intramedullary lengthening nails is a fast-developing field and represents an alternative to external fixators. Although previous studies have assessed the application of magnetically driven intramedullary lengthening nails, these studies have been heterogenous regarding the nailing approach, the bone treated, and the implant type; they also have analyzed relatively small patient groups at short follow-up durations. QUESTIONS/PURPOSES (1) Is femoral lengthening with magnetically driven antegrade intramedullary lengthening nails accurate and precise? (2) What are the most common complications of treatment? (3) What factors are associated with unplanned additional surgery? METHODS We retrospectively analyzed the longitudinally maintained database of our orthopaedic teaching hospital to identify all patients who underwent surgery for leg length discrepancy (LLD) between October 2014 and April 2019. In total, we surgically treated 323 patients for LLD of 2 cm or more. Of those 55% (177 of 323) were treated with distraction osteogenesis with magnetically driven intramedullary lengthening nails, 18% (59 of 323) with external fixation, and 27% (87 of 323) with epiphysiodesis around the knee. Based on that, 29% (93 of 323) of patients underwent unilateral femoral distraction osteogenesis with magnetically driven antegrade femoral lengthening nails and were eligible for analysis. No patient was excluded, and 3% (3 of 93) were lost before the minimum study follow-up of 2 years, leaving 97% (90 of 93) for analysis. Patients with a distal femoral deformity were treated via a retrograde femoral approach (10% [33 of 323]) or with external fixators (3% [10 of 323]) and were not included in this study. Distraction osteogenesis with magnetically driven intramedullary lengthening nails was not considered for patients with deep tissue infection, those with bone dimensions considered to be too small in relation to the available implants, and for patients younger than 8 years. This study included 90 patients (44 females, 43 left femora) treated for a median (interquartile range) preoperative LLD of 39 mm (32 to 52) at a median age of 15 years (14 to 17). The same limb lengthening system was applied in all patients. The median (IQR) follow-up was 35 months (24 to 78). Data were acquired through a chart review performed by someone not involved in the surgical care of the included patients. Data acquisition was supervised and curated by two of the involved surgeons. Accuracy was calculated as 100 - [(achieved distraction in mm - planned distraction in mm) / (planned distraction in mm) x 100] and precision as 100 - (relative standard deviation of accuracy). Treatment-associated complications were summarized descriptively and characterized as complications resulting in unplanned additional surgery or those not resulting in unplanned surgery. To analyze the risk of unplanned additional surgery by entity, we calculated odds ratios (ORs) comparing the incidence of unplanned additional surgery in the different entity cohorts with the idiopathic LLD cohort as a reference. By calculating ORs, we analyzed the risk for unplanned additional surgery depending on sex, age, surgery time, and previous lengthening. Due to the lack of long-term evidence about motorized lengthening nails remaining in situ and concerns about potential implant-related adverse effects, removal was routinely scheduled 1 year after consolidation. For implant removal, 92% (83 of 90) of patients underwent planned additional surgery, which was not recorded as an adverse event of the treatment. Ninety-seven percent (87 of 90) of patients completed lengthening with the implant remaining in situ until the end of distraction. The median (IQR) distraction length was 37 mm (30 to 45) with a median distraction index of 0.9 mm/day (0.7 to 1.0) and median consolidation index of 31 days/cm (25 to 42). RESULTS The calculated accuracy and precision were 94% and 90%, respectively. In total, 76% (68 of 90) of our patients experienced complications, which resulted in 20% (18 of 90) of patients undergoing unplanned additional surgery. The most common complication overall was adjustment of the distraction rate in 27% (24 of 90) of patients (faster: 16% [14 of 90]; slower: 11% [10 of 90]) and temporary restriction of knee motion, which occurred in 20% (18 of 90) of our patients and resolved in all patients who experienced it. The most serious complications were bacterial osteomyelitis and knee subluxation, which occurred in 3% (3 of 90) and 1% (1 of 90) of our patients, respectively. With the numbers available, we found only one factor associated with an increased likelihood of unplanned additional surgery: Patients with postinfectious LLD had higher odds of unplanned additional surgery than patients with idiopathic LLD (7% [1 of 15] versus 50% [3 of 6], OR 14.0 [95% CI 1.06 to 185.49]; p = 0.02). However, we caution readers this finding is fragile, and the confidence interval suggests that the effect size estimate is likely to be imprecise. CONCLUSION Femoral distraction osteogenesis with magnetically driven antegrade intramedullary lengthening nails appears to be an accurate and reliable treatment for femoral lengthening. However, depending on the etiology, a high risk of unplanned additional surgery should be anticipated, and a high proportion of patients will experience temporary joint stiffness. We recommend close orthopaedic follow-up and physiotherapy during treatment. This treatment of LLD can be considered alongside other nails, external fixators, and epiphysiodesis. Multicenter studies comparing this with other approaches are needed. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Adrien Frommer
- Pediatric Orthopaedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, Muenster, Germany
| | - Robert Roedl
- Pediatric Orthopaedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, Muenster, Germany
| | - Georg Gosheger
- General Orthopaedics and Tumor Orthopaedics, University Hospital Muenster, Muenster, Germany
| | - Maike Niemann
- Pediatric Orthopaedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, Muenster, Germany
| | - Dominik Turkowski
- Pediatric Orthopaedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, Muenster, Germany
| | - Gregor Toporowski
- Pediatric Orthopaedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, Muenster, Germany
| | - Christoph Theil
- Pediatric Orthopaedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, Muenster, Germany
| | - Andrea Laufer
- Pediatric Orthopaedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, Muenster, Germany
| | - Bjoern Vogt
- Pediatric Orthopaedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, Muenster, Germany
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Melikov EA, Dibirov TM, Klipa IA, Drobyshev AY. [Alveolar distraction osteogenesis: possible complications and methods of their treatment]. Stomatologiia (Mosk) 2022; 101:25-30. [PMID: 35362699 DOI: 10.17116/stomat202210102125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The aim of the study. Analysis of emerging complications during the method of alveolar distraction osteogenesis in patients with jaw defects. A retrospective analysis of foreign and domestic literature was carried out. A systematic literary search was carried out in the electronic bibliographic databases Web of Science (for foreign articles) and Elibrary and Dissercat (for domestic). MATERIAL AND METHODS In the period from 2005 to 2019 in the clinic of the Department of Maxillofacial and Plastic Surgery of the Moscow State Medical University. Evdokimov conducted an examination and comprehensive treatment of 490 patients with primary and secondary adentia of the upper and lower jaws, accompanied by a significant deficiency of bone tissue of the alveolar ridge vertically. A comprehensive dental rehabilitation of patients with jaw defects by the method of distraction osteogenesis was carried out. RESULTS The most common complications are: exposure of the fixation modules of the distraction apparatus - 24% of cases, failure of bone regenerate - 13%, inflammatory phenomena - 13%, displacement of the distraction vector - 43%, paresthesia - 7%. CONCLUSION Based on our analysis of the identified complications during the distraction osteogenesis method, it was found that these complications are not critical in the treatment of patients with jaw bone deficiency and do not jeopardize the success of rehabilitation. With diagnosis and timely approach to treatment, complications are avoidable.
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Affiliation(s)
- E A Melikov
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - T M Dibirov
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - I A Klipa
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - A Y Drobyshev
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
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Horiuchi S, Sato H, Iwasa A, Ichihara A, Tenshin H, Watanabe K, Hiasa M, Hashimoto I, Tanaka E. Long-term Management of a Patient with Apert Syndrome. J Contemp Dent Pract 2021; 22:1184-1190. [PMID: 35197388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
AIM AND OBJECTIVE To present an Apert syndrome patient with midfacial growth deficiency treated with Le Fort III distraction osteogenesis and subsequent two-jaw surgery. BACKGROUND Apert syndrome is expressed as a severe and irregular craniosynostosis, midfacial hypoplasia, and symmetric syndactyly in the fingers and toes. For craniosynostosis syndromes, treatment planning is complex due to the disharmony between facial profile and occlusion. CASE DESCRIPTION A 4-year-and-5-month-old boy, diagnosed with Apert syndrome, showed a concave profile accompanied with midfacial hypoplasia, moderate exorbitism, a reversed occlusion of -10.0 mm, an anterior open bite of -5.0 mm, and skeletal class III jaw-base relationship. The patient, aged 15 years and 4 months, underwent a Le Fort III osteotomy, and subsequent osteodistraction was performed via a rigid external distraction (RED) device. His midfacial bone was advanced by approximately 7.0 mm. One year after the distraction, preoperative treatment with 0.018-in preadjusted edgewise appliances was initiated. Two-jaw surgery with a Le Fort I osteotomy and bilateral sagittal split ramus osteotomy was performed after 42 months of preoperative orthodontic treatment. At the age of 20 years and 9 months, his facial profile dramatically changed to a straight profile, and an acceptable occlusion with an adequate interincisal relationship was obtained. A functional occlusion with an excellent facial profile was maintained throughout the 2-year retention period, although the upper dental arch width was slightly decreased, resulting in the recurrence of the left posterior crossbite. CONCLUSION Our report indicates the necessity of long-term follow-up in patients with craniosynostosis because of syndrome-specific growth and methodologically induced relapse. CLINICAL SIGNIFICANCE The two-stage operation combining early distraction osteogenesis and postgrowth orthognathic surgery proves to be an effective therapy for correcting midfacial hypoplasia and skeletal mandibular protrusion caused by Apert syndrome.
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Affiliation(s)
- Shinya Horiuchi
- Department of Orthodontics and Dentofacial Orthopedics, Tokushima University Hospital, Tokushima, Japan
| | - Hiroko Sato
- Department of Orthodontics and Dentofacial Orthopedics, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Akihiko Iwasa
- Department of Orthodontics and Dentofacial Orthopedics, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Aki Ichihara
- Department of Orthodontics and Dentofacial Orthopedics, Tokushima University Hospital, Tokushima, Japan
| | - Hirofumi Tenshin
- Department of Orthodontics and Dentofacial Orthopedics, Tokushima University Hospital, Tokushima, Japan
| | - Keiichiro Watanabe
- Department of Orthodontics and Dentofacial Orthopedics, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Masahiro Hiasa
- Department of Orthodontics and Dentofacial Orthopedics, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Ichiro Hashimoto
- Department of Plastic and Reconstructive Surgery, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Eiji Tanaka
- Department of Orthodontics and Dentofacial Orthopedics, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan; Department of Orthodontics, King Abdulaziz University, Jeddah, Saudi Arabia, Phone: +81-88-6337356, e-mail:
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Abstract
Monobloc and bipartition advancement by external distraction plays a major role in the treatment of syndromic craniosynostosis. They can reverse the associated facial deformity and play a role in the management of ocular exposure, intracranial hypertension, and upper airway obstruction. Facial bipartition distraction corrects the intrinsic facial deformities of Apert syndrome. Both procedures are associated with relatively high complication rates principally related to ascending infection and persistent cerebrospinal fluid leaks. Modern perioperative management has resulted in a significant decline in complications. External distractors allow fine tuning of distraction vectors and improve outcome but are less well tolerated than internal distractors.
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Affiliation(s)
- David J Dunaway
- Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 7JH, UK.
| | - Curtis Budden
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, 8440 112 Street, Edmonton, AB T6G 2B7, Canada
| | - Juling Ong
- Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 7JH, UK
| | - Greg James
- Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 7JH, UK
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Johnson MA, Lott C, Qiu C, Galagedera N, Flynn JM, Cahill PJ, Anari JB. Rib-based Distraction Device Implantation Before Age 3 Associated With Higher Unplanned Rate of Return to the Operating Room. J Pediatr Orthop 2021; 41:e369-e373. [PMID: 33782371 DOI: 10.1097/bpo.0000000000001823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Surgical treatment of early-onset scoliosis (EOS) with rib-based implants such as the vertical expandable prosthetic titanium rib (VEPTR) is associated with a high rate of complications including surgical site infection, skin breakdown, and implant migration. Many of these complications warrant the need for unplanned reoperations, increasing the burden on an already vulnerable patient population, and introducing the further risk of infection. To provide insight into the risks of early intervention, we investigate the relationship between initial device implantation before the age of 3 and the rate of unplanned reoperation. METHODS A retrospective review was performed of all patients at a single institution who had undergone VEPTR insertion for EOS with at least a 2-year follow-up from 2007 to 2016. Patients were stratified into the case-cohort (0 to 2 y of age) or the comparison cohort (3 to 10 y of age) based on age at the time of device implantation. Multivariate regression accounting for age and scoliosis etiology was performed to identify factors predictive of unplanned reoperation. RESULTS A total of 137 of 185 patients treated with VEPTR were identified with 76 (56%) undergoing at least 1 unplanned reoperation during the study time period. There were 68 and 69 patients in the age 0- to 2-year and 3- to 10-year cohorts, respectively. Patients aged 0 to 2 years underwent a higher number of total procedures compared with those aged 3 to 10 (13.1±6.5 vs. 10.6±4.8, P=0.032). A significant difference was found in the rate of unplanned reoperation between the 2 cohorts with 44 (65%) patients aged 0 to 2 and 32 (46%) patients aged 3 to 10 undergoing at least 1 unplanned reoperation (P=0.031). Binary logistic multivariate regression accounting for age and scoliosis etiology demonstrated that patients aged 0 to 2 had a significantly greater odds of undergoing an unplanned reoperation (odds ratio=3.050; 95% confidence interval: 1.285-7.241; P=0.011) compared with patients aged 3 to 10 years. CONCLUSION Overall, EOS patients aged 0 to 2 at initial VEPTR implantation are up to 3 times higher risk of undergoing an unplanned reoperation compared with those aged 3 to 10. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Mitchell A Johnson
- Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
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Balci Hİ, Bayram S, Pehlivanoglu T, Anarat FB, Eralp L, Şen C, Kocaoğlu M. Effect of lengthening speed on the quality of callus and complications in patients with congenital pseudarthrosis of tibia. Int Orthop 2021; 45:1517-1522. [PMID: 33792758 DOI: 10.1007/s00264-021-05011-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 03/16/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE This study aims to evaluate the effect of lengthening speed on the quality of callus and complications during distraction osteogenesis and describe an optimal lengthening speed in patients with congenital pseudarthrosis of tibia (CPT). METHODS Twenty-seven patients with CPT with a minimum follow-up of 36 months who underwent limb lengthening surgery between 1997 and 2016 with external fixator only were included in this study. All patients underwent lengthening procedures after achieving complete bone union in this study. Regenerate quality is evaluated according to the Li classification on the X-ray taken one month after the end of the distraction period. Complications were noted in post-operative follow-up period. Receiver operator characteristics (ROC) curve analysis was performed to obtain optimal lengthening speed for these patients. RESULT The mean age at the time of surgery was 5.74 years. The mean lengthening speed was 0.596 mm/day. Follow-up period of 136.14 months with a mean lengthening period of 92.4 days. Mean amount of lengthening was 5.44 cm for patients with CPT. Total rate of callus with good morphological quality was calculated as 66%. According to ROC analysis, optimal cut-off values of lengthening speed for the obtaining good morphological quality callus was 0.564 mm/day for tibial lengthening in CPT. There was a significantly positive correlation between complication rate and lengthening speed for each group. CONCLUSION We recommend a mean lengthening rate of 0.56mm/day for the lengthening procedures with external fixator in patients with CPT who had complete bone union at the area of pseudarthrosis.
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Affiliation(s)
- Halil İbrahim Balci
- Department of Orthopedics and Traumatology, Istanbul University, Istanbul Faculty of Medicine, Turgut Özal Millet Cd, 34093, Istanbul, Turkey
| | - Serkan Bayram
- Department of Orthopedics and Traumatology, Istanbul University, Istanbul Faculty of Medicine, Turgut Özal Millet Cd, 34093, Istanbul, Turkey.
| | - Tuna Pehlivanoglu
- Department of Orthopedics and Traumatology, Emsey Hospital, Istanbul, Turkey
| | - Fikret Berkan Anarat
- Department of Orthopedics and Traumatology, Istanbul University, Istanbul Faculty of Medicine, Turgut Özal Millet Cd, 34093, Istanbul, Turkey
| | - Levent Eralp
- Department of Orthopedics and Traumatology, Istanbul University, Istanbul Faculty of Medicine, Turgut Özal Millet Cd, 34093, Istanbul, Turkey
| | - Cengiz Şen
- Department of Orthopedics and Traumatology, Istanbul University, Istanbul Faculty of Medicine, Turgut Özal Millet Cd, 34093, Istanbul, Turkey
| | - Mehmet Kocaoğlu
- Department of Orthopedics and Traumatology, Unimed Center, Istanbul, Turkey
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Wang B, Zhai J, Zheng Y, Tong H, Lü Y, Chen Z, Yin N, Song T. Temporomandibular joint dislocation in patients with cleft lip and palate after maxillary distraction osteogenesis: Three case reports. Medicine (Baltimore) 2021; 100:e24012. [PMID: 33578517 PMCID: PMC7886453 DOI: 10.1097/md.0000000000024012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 12/03/2020] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Distraction osteogenesis (DO) is a widely used for cleft and palate related maxillary hypoplasia. There has been little research on temporomandibular joint (TMJ) dislocation after maxillary DO. We present these 3 cases and analyze the possible causes for reference by other clinicians. PATIENT CONCERNS In the late stages of maxillary DO, the patients gradually felt a decrease in mandibular mobility and suffered from limited mouth opening. Case 2 and 3 could open their mouth up to 1 and 2 fingers and Case 1 barely able to open her mouth at the completion of distraction. DIAGNOSIS Case 1 and Case 3 were diagnosed as right TMJ dislocation and Case 2 had a TMJ dislocation on her left side. INTERVENTIONS Patients with TMJ dislocation were repositioned with manipulation as soon as detected. OUTCOMES There was no recurrence in all three cases during the postoperative follow-up period. CONCLUSIONS Maxillary DO can sufficiently advance the maxilla in cleft lip and palate patients. Clinicians should be mindful of the TMJ dislocations that maxillary DO can exert on patients.
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Affiliation(s)
| | - Junya Zhai
- Center for Cleft Lip and Palate Treatment
| | | | | | - Yang Lü
- Center for Cleft Lip and Palate Treatment
| | - Zhewei Chen
- Center of Maxillofacial Surgery and Digital Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | - Tao Song
- Center for Cleft Lip and Palate Treatment
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Liu XN, Chang F, Zhang HY, Zhong Z, Xue P, Huang BZ. Ankle distraction arthroplasty for the treatment of severe ankle arthritis: Case report, technical note, and literature review. Medicine (Baltimore) 2020; 99:e22330. [PMID: 32991444 PMCID: PMC7523852 DOI: 10.1097/md.0000000000022330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Widely applied in the treatment of severe ankle arthritis (AA), ankle distraction arthroplasty (ADA) can avoid not only the ankle range of motion loss but also ankle fusion. However, the clinical outcomes of ADA for severe AA are poorly understood. This study aims to present our clinical outcomes of severe AA treated by ADA. PATIENT CONCERNS A 53-year-old man suffered right ankle sprain 10 years ago, endured right ankle pain and limited movement for 6 years. DIAGNOSIS The patient was diagnosed as severe AA. INTERVENTIONS He received ankle distraction arthroplasty. No adjuvant procedures were performed. The visual analog scale (VAS), the American Orthopaedic Foot and Ankle Society (AOFAS) score, the short-form (SF)-36 physical component summary (PCS) score and ankle activity score (AAS) were recorded to access the clinical outcomes pre- and postoperatively. Moreover, ankle joint space distance was evaluated on weight-bearing radiographs. OUTCOMES The patient derived effective pain relief and restored a satisfactory range of movement. There was a 13-month follow-up period after frame removal. The AOFAS score improved from 56 preoperatively to 71 postoperatively. The VAS score decreased from 6 prior to surgery to 1 after surgery. The SF-36 PCS was 47.2 and 71.8 pre- and postoperative, respectively. The AAS scores were improved from 3.4 preoperatively to 7.3 postoperatively. LESSONS ADA is reliable to achieve pain relief, functional recovery, and serve AA resolution. Besides, it is an alternative to ankle arthrodesis or total ankle arthroplasty in selected patients with severe AA.
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Skov ST, Bünger C, Li H, Vigh-Larsen M, Rölfing JD. Lengthening of magnetically controlled growing rods caused minimal pain in 25 children: pain assessment with FPS-R, NRS, and r-FLACC. Spine Deform 2020; 8:763-770. [PMID: 32170659 DOI: 10.1007/s43390-020-00096-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 02/25/2020] [Indexed: 11/24/2022]
Abstract
STUDY DESIGN Descriptive case series. OBJECTIVE The aim of the study is to investigate the pain associated with magnetically controlled growing rod (MCGR) lengthening procedures. MCGRs have gained popularity because they offer non-surgical lengthening procedures in early-onset scoliosis (EOS) instead of semi-annual open surgery elongations with traditional growing rods. Many aspects of MCGR treatment have been investigated, but pain in conjunction with distraction is only sparsely described in the literature. METHODS Pain intensity was assessed in 25 EOS patients before, during and after MCGR lengthening procedures in an outpatient setup. They underwent at least two (range 2-16) lengthening procedures prior to this study. The pain intensity was estimated using patient-reported Faces Pain Scale (FPS-R), caregiver-reported pain numeric rating scale (NRS), and NRS and revised Face, Legs, Activity, Cry, Consolability scale (r-FLACC) by two medically trained observers. The inter-rater reliability and correlation between instruments were analyzed. RESULTS 23 of 25 EOS patients (8- to 16-year old) with mixed etiology were able to self-report pain. The average pain intensity was mild: median 1 (range 0-6) on all four instruments on a 0-to-10 scale. Afterward, 22/25 patients (88%) were completely pain free and the remaining 3 patients had a pain score of 1. MCGR stalling (i.e. clunking) was encountered in 14/25 (56%) of the patients without impact on the pain intensity. CONCLUSIONS The average maximum pain intensities during the lengthening procedures were mild and pain ceased within few minutes. The inter-rater reliability was good to excellent for NRS and r-FLACC, and there were high correlations between all the four pain instruments, indicating high criterion validity. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Simon Toftgaard Skov
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark.
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
- Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark.
| | - Cody Bünger
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Haisheng Li
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
| | - Marianne Vigh-Larsen
- Department of Surgery & Anesthesiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jan Duedal Rölfing
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- MidtSim, Central Denmark Region, Aarhus, Denmark
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Cahill PJ, Campbell RE, Lakomkin N, Flynn JM, Nance ML, Mayer OH, Taylor JA, Baldwin KD, Campbell RM. Comprehensive Wound Risk Stratification of Rib-Based Distraction Instrumentation Procedures. Spine Deform 2019; 7:971-978. [PMID: 31732010 DOI: 10.1016/j.jspd.2019.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 03/11/2019] [Accepted: 04/28/2019] [Indexed: 11/19/2022]
Abstract
STUDY DESIGN Single-center retrospective analysis of a prospectively collected registry. OBJECTIVES Identify factors predictive of rib-based distraction (RBD) instrumentation wound complication. Create a risk stratification model for RBD instrumentation wound complication. SUMMARY OF BACKGROUND DATA RBD instrumentation procedures have a high rate of wound complications, often requiring unplanned operative treatment. Currently, there is a relative lack of understanding of RBD complication risk factors compared with the comprehensive understanding of complication risk factors for other spine surgeries. METHODS Between January 2011 and September 2015, patients treated with RBD instrumentation at a single institution were analyzed for risk factors associated with surgical wound complications that resulted in unplanned operative treatment. Univariate logistic regression determined predictors of wound complication and multivariate regression determined independent predictive factors; α = 0.10. RESULTS A total of 122 patients aged 0-18 years underwent 140 implant surgeries in which 22 resulted in complications: 18 (82%) infectious and 4 (18%) noninfectious. Mean age at surgery was 5.2 years. Univariate analysis showed a correlation between wound complication rates and the following: male gender (p = .097), diapered patient with lower back incision (p = .004), bilateral procedure (p = .008), more than three incisions (p = .011), left iliac incision (p = .097), right iliac incision (p = .009), patient age ≤4 years (p = .10), and operative time >150 minutes (p = .079). Multivariate analysis identified the following independent predictors: age ≤ 4 years (p = .002), male gender (p = .04), number of skin incisions (p = .001), left iliac incision (p = .018), and nutritionally challenged (p = .044). The multivariate model predicted wound complications with an area under the receiver operating characteristic curve of 0.88. CONCLUSIONS Knowledge of risk factors for RBD instrumentation wound complications can be used to construct patient risk models. This can identify patients at higher risk for complications and influence clinical decision making. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Patrick J Cahill
- Division of Orthopaedics, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA.
| | - Richard E Campbell
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Nikita Lakomkin
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029, USA
| | - John M Flynn
- Division of Orthopaedics, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Michael L Nance
- Division of Pediatric General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Oscar H Mayer
- Division of Pulmonary Medicine, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Jesse A Taylor
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Keith D Baldwin
- Division of Orthopaedics, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Robert M Campbell
- Division of Orthopaedics, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
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Haller JM, Heflin JA, Hulet DA, Ding Q, Presson AP, Smith JT. Intrawound Vancomycin Powder Associated With Reduced Surgical Site Infection in Rib-based Distraction Surgery. J Pediatr Orthop 2019; 39:e703-e707. [PMID: 31503228 DOI: 10.1097/bpo.0000000000001042] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Despite clinical reports of improved pulmonary function and reduced spinal deformity with rib-based distraction surgery in early-onset scoliosis (EOS) patients, infection remains a common complication, reported as high as 32% in some studies. The purpose of this study was to evaluate intrawound vancomycin powder in pediatric patients managed with rib-based distraction for EOS. METHODS This was a single institution retrospective cohort study of EOS patients treated with rib-based distraction. Patients treated with and without intrawound vancomycin were compared. Patients included were younger than 18 years of age, had undergone placement of a rib-based distraction construct, and had a minimum of 6 months' follow-up. For patients in the vancomycin group, 500 mg of vancomycin powder was placed before wound closure. Complications including infection and revision surgery were recorded. P-values and 95% confidence intervals (CIs) were reported for both unadjusted and adjusted complication rates for prevancomycin and postvancomycin powder. All P-values were calculated at a significance level of 0.05. RESULTS In total, 118 patients were included, accounting for 1035 procedures in the nonvancomycin control group and 252 procedures in the vancomycin group. Both groups were similar with regard to age at initial implant, sex, diagnosis, ambulatory status, and bowel/bladder incontinence. There were 55 (5.3%; 95% CI, 4.1-7.6) postoperative infections in the control group and 3 (1.2%; 95% CI, 0.3-3.8) in the vancomycin group (P=0.008, unadjusted). After adjusting for surgery type and transfusions, the vancomycin group still had a significantly lower infection rate (1.4%; 95% CI, 0.3-3.7 vs. 5.5%; 95% CI, 3.04-6.5; P=0.022). We were unable to demonstrate a difference between the control (3.5%, 95% CI, 2.4-5.1) and vancomycin (1.8%, 95% CI, 0.5-5.7) groups for deep infection (P=0.27). CONCLUSIONS Intrawound vancomycin powder significantly reduced the surgical site infection rates following rib-based distraction surgery for EOS. We therefore recommend the use of intrawound vancomycin powder as a standard of care for patients undergoing rib-based distraction surgery. LEVEL OF EVIDENCE Pre-post intervention, retrospective cohort study-therapeutic level III.
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Affiliation(s)
| | | | | | - Qian Ding
- Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, UT
| | - Angela P Presson
- Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, UT
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Abstract
BACKGROUND Implantable rib-based distraction devices have revolutionized the treatment of children with early onset scoliosis and thoracic insufficiency syndrome. Unfortunately, the need for multiple skin incisions and repeated surgeries in a fragile patient population creates considerable infection risk. In order to assess rates of infection for different incision locations and potential risk factors, we generated a prospectively collected database of patients treated with rib-based distraction devices. METHODS We analyzed a cohort of patients with thoracic insufficiency syndrome from various etiologies that our institution treated with rib-based distraction devices from 2013 to 2016. Surgery type (implantation, expansion, revision/removal), and surgeon adjudicated surgical site infection (SSI) were collected. For this study, we developed a novel, rib-based distraction device surgical site labeling system in which incisions could be labeled as either proximal or distal surgical exposure areas. Treating surgeons documented the operative site, procedure, and SSI site in real-time. RESULTS A total of 166 unique patients underwent 670 procedures during the study period, producing 1537 evaluable surgical sites; 1299 proximal and 238 distal. Patients were 6.81±4.0 years of age on average. Forty-seven procedures documented SSIs (7.0%), while 40 (24.1%) patients experienced an infection. Analysis showed significant variation in the rate of infection between implantation, and expansion, and revision procedures, with implantation procedures having the highest infection rate at 13.1% (P<0.01). Infections occurred more frequently at distal sites than proximal ones (P=0.02). CONCLUSIONS Our novel, surgeon-entered, prospective quality improvement database has identified distal surgical sites as being at higher risk for SSI than proximal ones. Further, rib-based distraction device implantation procedures were identified as being at a greater risk for SSI than expansion or revision procedures. We believe this data can lead to improved prevention measures, anticipatory guidance, and patient care. LEVEL OF EVIDENCE Level II-prognostic study.
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Satoh K, Nagata J, Shomura K, Wada T, Tachimura T, Fukuda J, Shiba R. Morphological Evaluation of Changes in Velopharyngeal Function following Maxillary Distraction in Patients with Repaired Cleft Palate during Mixed Dentition. Cleft Palate Craniofac J 2017; 41:355-63. [PMID: 15222793 DOI: 10.1597/02-153.1] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To describe the morphological changes of nasopharyngeal components after maxillary distraction and clarify whether the morphological characteristics are related to velopharyngeal function (VPF). Design Perceptual judgments of hypernasality and nasendoscopy were performed before and after treatment. Lateral cephalograms were obtained to describe the morphological changes. Setting Department of Oral and Maxillofacial Surgery, Miyazaki Medical College, Miyazaki, Japan. Participants Nine patients with repaired cleft palate in the mixed dentition stage underwent maxillary distraction using a face mask and an intraoral fixed appliance system. Outcome Measures The severity of hypernasality, velopharyngeal insufficiency, and measurements such as pharyngeal depth, velar length, and the rotation of the palatal plane were evaluated. Results Increase in pharyngeal depth was not always proportional to the amount of advancement. It depended on the posture of the posterior pharyngeal wall and the rotation of palatal plane. Conclusion Cephalometric measurements of the nasopharynx before and after surgery confirmed subsequent changes in VPF. These were suggested to be useful in predicting future VPF. When performing maxillary distraction in patients with cleft palate in the mixed dentition stage, and when velopharyngeal closure is found to occur by velar contact against the hypertrophied adenoid, patients should be counseled about risks of subsequent deterioration in their speech before surgery.
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Affiliation(s)
- Koichi Satoh
- Department of Oral and Maxillofacial Surgery, Kyushu Dental College, Kitakyushu, Japan.
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Zhang Q, Zhang W, Zhang Z, Zhang L, Chen H, Hao M, Deng J, Tang P. Femoral nonunion with segmental bone defect treated by distraction osteogenesis with monolateral external fixation. J Orthop Surg Res 2017; 12:183. [PMID: 29178906 PMCID: PMC5702156 DOI: 10.1186/s13018-017-0684-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 11/09/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Currently, the common treatment for femoral nonunion with large segmental bone defect is difficult and complex. The effective surgical methods are rare, include vascularized bone grafting, Masquelet technique and Ilizarov distraction osteogenesis. The objective of this study is to investigate the outcomes of segmental femoral defects treated with monolateral external fixation using the distraction osteogenesis. METHODS We retrospectively analyzed patients with femoral nonunion with segmental bone defects (> 6 cm) between January 2010 and January 2014 in our single trauma center. All patients were treated by distraction osteogenesis with monolateral external fixation. All surgeries were performed by the same surgeon. Bone union, duration of distraction osteogenesis in days, time to consolidation in months, external fixation index (EFI), complications, and additional surgical interventions were recorded postoperatively. The modified Application of Methods of Illizarov (ASAMI) criteria were used to evaluate the operative effectiveness. RESULTS Forty-one patients were enrolled in this study for analysis. The length of the bone defect ranged from 6 to 17 cm. All patients eventually achieved healing, and no patient experienced recurrence of infection or newly developed infection. The average time needed for healing was 13 months. In terms of the incidence of complications, 3 cases axial deviations, 5 cases docking site nonunion, 23 cases pin-tract infection, 14 cases knee joint stiffness or their joint mobility declined, 2 cases osteogenesis insufficient in the distraction area,1 case refracture, and 2 cases loose external fixation pins. In terms of the evaluations of fracture healing and function, 30 patients excellent, 6 patients good, 5 patients fair, and 0 patient poor. In terms of postoperative function evaluations, 21 patients excellent, 9 patients good, 7 patients fair, and 4 patients poor. CONCLUSION For patients with femoral nonunion with large segmental bone defects, the monolateral external fixation can provide effective stability, improve compliance, and reduce complications.
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Affiliation(s)
- Qun Zhang
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing, 100853 People’s Republic of China
| | - Wei Zhang
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing, 100853 People’s Republic of China
| | - Zhuo Zhang
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing, 100853 People’s Republic of China
| | - Licheng Zhang
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing, 100853 People’s Republic of China
| | - Hua Chen
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing, 100853 People’s Republic of China
| | - Ming Hao
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing, 100853 People’s Republic of China
| | - Junhao Deng
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing, 100853 People’s Republic of China
| | - Peifu Tang
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing, 100853 People’s Republic of China
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Imam MA, Holton J, Ernstbrunner L, Pepke W, Grubhofer F, Narvani A, Snow M. A systematic review of the clinical applications and complications of bone marrow aspirate concentrate in management of bone defects and nonunions. Int Orthop 2017; 41:2213-2220. [PMID: 28804813 DOI: 10.1007/s00264-017-3597-9] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 07/31/2017] [Indexed: 12/12/2022]
Abstract
PURPOSE Fracture healing encompasses a succession of dynamic multifactorial metabolic events, which ultimately re-establishes the integrity of the biomechanical properties of the bone. Up to 10% of the fractures occurring annually will need additional surgical procedures because of impaired healing. The aim of this article is to review the current literature regarding the use of bone marrow aspirate concentrate (BMAC) and its effectiveness in the management of bone defects. METHODS We have included all published clinical literature investigating the development, techniques and applications of BMAC. Language, design and risk of bias did not deter the initial inclusion of any study. Our search was exclusively limited to studies involving human subjects. A PRISMA compliant search was carried out as published in 2009. This included the online databases: PubMed, EMBASE, clinical trial.gov and the Cochrane library from 1960 to the end of May 2015. MeSH terms used included: "Bone" AND "Marrow" AND "Aspirate" AND "Concentrate" AND "Bone Defects" AND "NONUNION". Eligible studies were independently appraised by two authors using the Critical Appraisal Skills Program checklist. For the purpose of narrative review, relevant studies were included irrespective of methodology or level of evidence. RESULTS Thirty-four of the 103 (48 PubMed and 55 EMBASE) results yielded by the preliminary search were included. Exclusions included three duplicate records, six letters, 17 non-orthopaedics related studies and four records irrelevant to our search topic. The CASP appraisal confirmed a satisfactory standard of 31 studies. They all had clearly defined objectives, were well designed and conducted appropriately to meet them. The published studies reported the use of BMAC in non-union and fracture healing (15 studies), bone defects (nine studies), spine fusion (two studies), distraction osteogensis (two studies) and complications related to the use of BMAC (seven studies). CONCLUSIONS Stem cells found in BMAC have the potential to self-renew, undertake clonal expansion and differentiate into different musculoskeletal tissues. The commercial processing of BMAC needs to be optimized in order to achieve a consistent end product, which will provide predicable and translatable results. The future potential of cell characterization in order to determine the optimum cell for repair/regeneration of bone also needs to be explored. LEVEL OF EVIDENCE Systematic Review of minimum level IV studies.
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Affiliation(s)
- Mohamed A Imam
- Department of Trauma and Orthopaedics, Faculty of Medicine, Suez Canal University, Circular road, Ismailia, Egypt.
- The Royal Orthopaedic Hospital, Birmingham, UK.
- Rowley Bristow Orthopaedic Centre, Ashford and St Peters Hospitals, Chertsey, UK.
| | - James Holton
- The Royal Orthopaedic Hospital, Birmingham, UK
- Birmingham University, Birmingham, UK
| | - Lukas Ernstbrunner
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
- Department of Orthopaedics and TraumatologyParacelsus, Medical University, Muellner Hauptstrasse 48, 5020, Salzburg, Austria
| | - Wojciech Pepke
- Department of Orthopaedics, Universität Heidelberg, Heidelberg, Germany
| | - Florian Grubhofer
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Ali Narvani
- Rowley Bristow Orthopaedic Centre, Ashford and St Peters Hospitals, Chertsey, UK
| | - Martyn Snow
- The Royal Orthopaedic Hospital, Birmingham, UK
- Birmingham University, Birmingham, UK
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Reininger D, Rodriguez-Grandjean A, López-Quiles J. Analysis of Resorption and Need for Overcorrection in Alveolar Distraction Osteogenesis. Int J Oral Maxillofac Implants 2017; 31:865-9. [PMID: 27447154 DOI: 10.11607/jomi.4424] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate the degree of resorption that occurs following a period of consolidation in alveolar distraction osteogenesis and assess the amount of overcorrection necessary to achieve the planned height. MATERIALS AND METHODS A retrospective observational study was conducted comprising 19 surgically treated patients, where a total of 19 extraosseous distractors were placed. All patients undergoing surgery had a panoramic radiograph and a computed tomography scan, both at the end of distraction and at the end of the consolidation period. To assess the degree of resorption, the distance from the mandibular border, maxillary sinus floor, or nasal floor to the limit of the crestal bone following consolidation was compared with the height recorded at the end of the distraction period. RESULTS Resorption occurred in all cases ranging from 7% to 25%. CONCLUSION The presence of resorption reported from this study indicates that an overcorrection of at least 20% may be necessary when distraction osteogenesis is performed.
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Cobb ARM, Vourvachis M, Ahmed J, Wyatt M, Dunaway D, Hayward R. Aberrant facial flushing following monobloc fronto-facial distraction. J Craniomaxillofac Surg 2015; 43:1511-5. [PMID: 26293186 DOI: 10.1016/j.jcms.2015.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 07/14/2015] [Accepted: 07/14/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Patients with syndromic forms of craniosynostosis may experience functional problems such as raised intracranial pressure, proptosis, obstructive sleep apnoea and failure to thrive. The monobloc fronto-facial advancement with osteogenic distraction is increasingly used to correct these functional problems in one procedure as well as improve appearance. The authors report the phenomenon of post operative aberrant facial flushing - an unusual and previously unreported complication of the procedure. METHODS The case notes of 80 consecutive patients undergoing fronto-facial advancement by distraction using the rigid external distraction device (RED) were reviewed for features of aberrant facial flushing. RESULTS Four out of eighty individuals developed facial flushing after monobloc fronto-facial distraction using the rigid external distractor (RED) frame. All were female with Crouzon or Pfeiffer syndromes causing the severe functional problems for which they underwent the surgery. They were aged 6-8 years. Following removal of the frame, they developed intermittent but severe facial flushing. The flushing spontaneously settled in three patients after up to four years but persists in the other child seven years after her surgery. CONCLUSION Aberrant facial flushing is a rare but significant complication of monobloc fronto-facial surgery. It occurred in 4 of our 80 (5%) patients. The skull base osteotomies essential for the procedure are made anterior to the pterygopalatine ganglion and it is our contention that damage from these was responsible for a neuropraxia of its efferent nerve branches. A review of the autonomic control of the facial vascular system suggests that the phenomenon is due to an unequal process of recovery that leaves the cutaneous vasodilating parasympathetic or beta-adrenergic innervation relatively unopposed - a situation that persists until with time a normal balance of autonomic input is achieved.
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Affiliation(s)
- Alistair R M Cobb
- Department of Oral & Maxillofacial Surgery, United Hospitals Bristol NHS Trust, Bristol, UK.
| | - Michael Vourvachis
- Craniofacial Service, Great Ormond Street Hospital for Children, London, UK
| | - Jahangir Ahmed
- Department of Otolaryngology, Royal London Hospital, London, UK
| | - Michelle Wyatt
- Department of Paediatric Otolaryngology, Great Ormond Street Hospital for Children, London, UK
| | - David Dunaway
- Craniofacial Service, Great Ormond Street Hospital for Children, London, UK
| | - Richard Hayward
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children, London, UK
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Korolenkova MV. [Juvenile paradental cysts in children after mandible distraction: case-control study and clinical cases presentation]. Stomatologiia (Mosk) 2015; 94:36-40. [PMID: 27002701 DOI: 10.17116/stomat201594636-40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Seventy-five children aged 6-17 years (mean age 9.8±4.1 years) that received mandible distraction (MD) at the age of 0-17 years (mean age at MD 6.1±4.3) were included in the study. Indication for MD were hemifacial microsomia (n=41), Goldenhar syndrome (n=4), Robin sequence (n=10), Treacher, Collins syndrome (n=7) or acquired mandible underdevelopment (n=13). Control groups consisted of 22 children aged 5-14 years (mean age 7.0±3.7 years) with mandible underdevelopment of similar origin (hemifacial microsomia (n=15), Goldenhar syndrome (n=2), Robin sequence (n=4), Treacher, Collins syndrome (n=1)) with no history of MD and 80 healthy children aged 6-10 years (mean age 7.1±2.2 years). Case-control study results proved MD to be the risk factor for juvenile paradental cysts (JPCs) with the risk more prominent in early MD cases. JPCs often do not manifest clinically and may resolve spontaneously but in refractory cases lesion curettage without endodontic treatment is an adequate approach, as JPCs are usually not associated with pulp necrosis.
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Affiliation(s)
- M V Korolenkova
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
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Abstract
BACKGROUND During lower limb lengthening, distraction-induced muscle pain and surrounding joint contractures are frustrating complications for which few effective treatments are available. QUESTIONS/PURPOSES We evaluated Botulinum Toxin Type A (BtX-A) injection in the calf muscles during human tibial distraction osteogenesis. We hypothesized that it may decrease calf pain and increase ROM of the surrounding joints by reducing muscle stiffness. METHODS Between April 2010 and January 2011, we evaluated 36 patients undergoing bilateral tibia lengthening who met prespecified inclusion criteria. All patients underwent stature lengthening with lengthening over a nail or lengthening and then nailing. BtX-A (200 IU) was injected at the calf muscle only in one leg for each patient and the same amount of sterile normal saline was injected into the other leg as a control. Selection of the leg receiving the toxin was randomized. Clinical evaluation included a VAS score for calf pain and measurement of ROM of the knees and ankles and calf circumference, with evaluations performed in a double-blinded manner. Side-to-side differences were analyzed until the end of consolidation phase. Minimum followup was 24 months (mean, 30 months; range, 24-39 months). The distraction rate and the final length gain were similar in the treated and control limbs. A priori power analysis suggested that 34 legs were required to achieve statistical significance of 0.05 with 80% of power to detect a 50% difference in treatment effect between treatment and control groups. RESULTS There were no differences in calf pain, knee and ankle ROM, and maximal calf circumferences between the two legs at each time point. CONCLUSIONS Local injection of 200 IU BtX-A at the human calf muscle does not appear to reduce calf pain or help enhance ROM of the knee and ankle during tibial lengthening. However, the small sample size provided sufficient power to detect only relatively large clinical effects; future, larger trials will be needed to determine whether smaller differences are present. LEVEL OF EVIDENCE Level II, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Dong Hoon Lee
- Department of Orthopaedic Surgery, Severance Hospital, College of Medicine, Yonsei University, 134 Sinchondong, CPO Box 8044, Seoul, Republic of Korea,
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Deshpande SS, Donneys A, Kang SY, Page EE, Felice PA, Kiryakoza L, Nelson NS, Rodriguez J, Deshpande SS, Buchman SR. Vascular analysis as a proxy for mechanostransduction response in an isogenic, irradiated murine model of mandibular distraction osteogenesis. Microvasc Res 2014; 95:143-8. [PMID: 25173587 DOI: 10.1016/j.mvr.2014.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 08/20/2014] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Head and neck cancer is a debilitating and disfiguring disease. Although numerous treatment options exist, an array of debilitating side effects accompany them, causing physiological and social problems. Distraction osteogenesis (DO) can avoid many of the pathologies of current reconstructive strategies; however, due to the deleterious effects of radiation on bone vascularity, DO is generally ineffective. This makes investigating the effects of radiation on neovasculature during DO and creating quantifiable metrics to gauge the success of future therapies vital. The purpose of this study was to develop a novel isogenic rat model of impaired vasculogenesis of the regenerate mandible in order to determine quantifiable metrics of vascular injury and associated damage. METHODS Male Lewis rats were divided into two groups: DO only (n=5) AND Radiation Therapy (XRT)+DO (n=7). Afterwards, a distraction device was surgically implanted into the mandible. Finally, they were distracted a total of 5.1mm. Animals were perfused with a radiopaque casting agent concomitant with euthanasia, and subsequently demineralization, microcomputed tomography, and vascular analysis were performed. RESULTS Vessel volume fraction, vessel thickness, vessel number, and degree of anisotropy were diminished by radiation. Vessel separation was increased by radiation. CONCLUSION The DO group experienced vigorous vessel formation during distraction and neovascularization with a clear, directional progression, while the XRT/DO group saw weak vessel formation during distraction and neovascularization. Further studies are warranted to more deeply examine the impairments in osteogenic mechanotransductive pathways following radiation in the murine mandible. This isogenic model provides quantifiable metrics for future studies requiring a controlled approach to immunogenicity.
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Affiliation(s)
- Sagar S Deshpande
- Craniofacial Research Laboratory, University of Michigan Health System, Ann Arbor, MI, United States
| | - Alexis Donneys
- Craniofacial Research Laboratory, University of Michigan Health System, Ann Arbor, MI, United States
| | - Stephen Y Kang
- Craniofacial Research Laboratory, University of Michigan Health System, Ann Arbor, MI, United States; Department of Otolaryngology, University of Michigan Health System, Ann Arbor, MI, United States
| | - Erin E Page
- College of Literature, Science, and Arts, University of Michigan, Ann Arbor, MI, United States
| | - Peter A Felice
- Department of General Surgery, University of South Carolina, Charleston, SC, United States
| | - Lauren Kiryakoza
- College of Literature, Science, and Arts, University of Michigan, Ann Arbor, MI, United States
| | - Noah S Nelson
- Craniofacial Research Laboratory, University of Michigan Health System, Ann Arbor, MI, United States
| | - Jose Rodriguez
- Craniofacial Research Laboratory, University of Michigan Health System, Ann Arbor, MI, United States
| | - Samir S Deshpande
- Craniofacial Research Laboratory, University of Michigan Health System, Ann Arbor, MI, United States; Kalamazoo College, Kalamazoo, MI, United States
| | - Steven R Buchman
- Craniofacial Research Laboratory, University of Michigan Health System, Ann Arbor, MI, United States; Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI, United States.
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Hoogeveen EJ, Jansma J, Ren Y. Surgically facilitated orthodontic treatment: a systematic review. Am J Orthod Dentofacial Orthop 2014; 145:S51-64. [PMID: 24680025 DOI: 10.1016/j.ajodo.2013.11.019] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 11/01/2013] [Accepted: 11/01/2013] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Corticotomy and dental distraction have been proposed as effective and safe methods to shorten orthodontic treatment duration in adolescent and adult patients. A systematic review was performed to evaluate the evidence supporting these claims. METHODS PubMed, Embase, and Cochrane databases were searched until April 2013 for randomized controlled trials, controlled clinical trials, and case series with 5 or more subjects that focused on velocity of tooth movement, reduction of treatment duration, or complications with various surgical protocols. There were no language restrictions during the search phase. Publications were systematically assessed for eligibility, and 2 observers graded the methodologic quality of the included studies with a predefined scoring system. RESULTS Eighteen articles met the inclusion criteria. Seven studies were clinical trials, with small investigated groups. Only studies of moderate and low values of evidence were found. Surgically facilitated treatment was indicated for various clinical problems. All publications reported temporarily accelerated tooth movement after surgery. No deleterious effects on the periodontium, no vitality loss, and no severe root resorption were found in any studies. However, the level of evidence to support these findings is limited owing to shortcomings in research methodologies and small treated groups. No research concerning long-term stability could be included. CONCLUSIONS Evidence based on the currently available studies of low-to-moderate quality showed that surgically facilitated orthodontics seems to be safe for the oral tissues and is characterized by a temporary phase of accelerated tooth movement. This can effectively shorten the duration of orthodontic treatment. However, to date, no prospective studies have compared overall treatment time and treatment outcome with those of a control group. Well-conducted, prospective research is still needed to draw valid conclusions.
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Affiliation(s)
- Eelke J Hoogeveen
- Orthodontist, Department of Orthodontics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Johan Jansma
- Maxillofacial surgeon, Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Yijin Ren
- Professor and orthodontist, Department of Orthodontics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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Pandyan DA, Siroraj P, Narayanan CD. Pseudoaneurysm of internal maxillary artery--an untold complication following distraction osteogenesis--a case report. J Oral Maxillofac Surg 2014; 72:605.e1-7. [PMID: 24528567 DOI: 10.1016/j.joms.2013.11.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 11/06/2013] [Accepted: 11/11/2013] [Indexed: 11/19/2022]
Abstract
Pseudoaneurysm of the internal maxillary artery is very rare and only a handful of cases have been reported in the literature thus far and none after placement of a prosthetic condyle and a distraction device. This case report highlights the need for early diagnosis, appropriate steps in management, and a multidisciplinary approach in a tertiary care center in treating this life-threatening condition and proper treatment planning to prevent this condition.
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Affiliation(s)
- Deepak Abraham Pandyan
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Sri Ramachandra Medical Center, Chennai, India
| | - Pearlcid Siroraj
- Resident, Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Sri Ramachandra Medical Center, Chennai, India.
| | - C D Narayanan
- Professor, Department of General Surgery, Sri Ramachandra Medical Center, Chennai, India
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Jordan CJ, Goldstein RY, McLaurin TM, Grant A. The evolution of the Ilizarov technique: part 1: the history of limb lengthening. Bull Hosp Jt Dis (2013) 2013; 71:89-95. [PMID: 24032588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The history of limb-lengthening surgery can be traced back to the nineteenth century. Since that time, the orthopaedic community has made tremendous progress in performing successful lengthening procedures. Among the important contributors to the field, Dr. Gavril Ilizarov remains one of the most significant innovators. Because of advancements over the past century, limb lengthening has become a viable method of treating severe bony deformities and defects. This article, the first of a two-part series, reviews the history of distraction osteosynthesis.
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Goldstein RY, Jordan CJ, McLaurin TM, Grant A. The evolution of the Ilizarov technique: part 2: the principles of distraction osteosynthesis. Bull Hosp Jt Dis (2013) 2013; 71:96-103. [PMID: 24032589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The history of limb-lengthening surgery can be traced back to the 19th Century. Since that time, the orthopaedic community has made tremendous progress in performing successful lengthening procedures. Among the important contributors to the field is Dr. Gavril Ilizarov. Because of advancements over the past century, limb lengthening has become a viable method of treating severe bony deformities and defects. This article, the second of a two-part series, reviews the principles of distraction osteosynthesis, including a thorough discussion of indications, instrumentation, and surgical technique.
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Stupina TA, Shchudlo MM, Shchudlo NA. [Changes in the knee joint synovial membrane and articular cartilage during shin lengthening by autodistractor at increased daily rate]. Morfologiia 2013; 143:66-70. [PMID: 24020187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Light microscopy and computerized morpho- and stereometry were used to examine the changes in the knee joint articular cartilage and synovial membrane studied during experimental canine shin lengthening by 15% of initial length by autodistraction at increased rate - 3 mm per day with switching on the automatic device 120 times. By the end of distraction period (10 days) the destructive changes in articular cartilage were more marked in the superficial and deep zones, synovitis of moderate and mild degree was observed accompanied by the destructive changes in the blood vessels and nerves of the subsynovial layer. Regeneration of articular cartilage was incomplete, and regressive neurovascular changes persisted in synovial membrane 30 days after the device removal. Comparison of these results with the previous data obtained using the distraction rate of 3 mm applied 180 times, leads to the conclusion, significant for functional prognosis, of the worsening the parameters of structural cartilage recovery in case of distraction pitch increase from 0.017 mm to 0.025 mm.
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Affiliation(s)
- T A Stupina
- Ilizarov Scientific Center for Restorative Traumatology and Orthopedics, Kurgan, Russia
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Volpon JB. Comparison between innominate osteotomy and arthrodistraction as a primary treatment for Legg-Calvé-Perthes disease: a prospective controlled trial. Int Orthop 2012; 36:1899-905. [PMID: 22810494 DOI: 10.1007/s00264-012-1598-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 06/05/2012] [Indexed: 11/26/2022]
Abstract
PURPOSE Legg-Calvé-Perthes (LCP) disease is currently managed by mechanical containment of the femoral head in the hip socket. As evidence suggests that hip distraction may offer a new treatment strategy, we used arthrodistraction as a primary treatment for active forms of LCP disease and prospectively compared the results with the Salter innominate osteotomy. METHODS A total of 54 children, six years or older of both genders with severe forms of LCP disease in the stages of necrosis or revascularisation, were enrolled. Patients were submitted to either Salter innominate osteotomy (n = 28) or hip arthrodistraction (n = 26). Final radiographs were used to evaluate the Mose index, Wiberg angle, extrusion index and the Stulberg et al. classification. RESULTS There were no significant differences in gender, age, lateral pillar classification and average follow-up time between the two groups. The osteotomy group progressed without major complications, but children in the joint distraction group experienced episodes of pin tract pain and infection, leading to the early removal of the external device in one case. Two patients developed joint stiffness, treated by physiotherapy or manipulation, and one child developed subluxation of the femoral head. The average time in distraction was 4.44 months (2.53-7.23 months). In the final evaluation the osteotomy group showed better containment of the femoral head. The Mose index and the Stulberg et al. classification were statistically similar between the two groups. CONCLUSIONS Despite similar final radiological results, arthrodistraction was associated with a higher morbidity. Consequently, we do not recommend hip distraction as a primary treatment for the early stages of LCP disease.
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Affiliation(s)
- José Batista Volpon
- Department of Biomechanics, Medicine and Rehabilitation of the Locomotor System, Ribeirão Preto Medical School, University of São Paulo, Av Bandeirantes 3900, 14049-900 Ribeirão Preto, Brazil.
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Wan J, Ling L, Zhang XS, Li ZH. Femoral bone transport by a monolateral external fixator with or without the use of intramedullary nail: a single-department retrospective study. Eur J Orthop Surg Traumatol 2012; 23:457-64. [PMID: 23412151 DOI: 10.1007/s00590-012-1008-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Accepted: 05/02/2012] [Indexed: 12/30/2022]
Abstract
BACKGROUNDS Treatment for bone defect remains a challenge for orthopedists. Bone transport gives an effective alternative, which can be performed with an external fixator alone or combined with an intramedullary nail. Each has its advantages and disadvantages. We present a retrospective study to find out the optimal choice by evaluating the outcomes of treatment for femoral bone defect with two methods. METHODS Two groups of patients, the monolateral external fixator alone (group A, n = 13) and the monolateral external fixator combined with intramedullary nail (group B, n = 15), were compared. Duration of the external fixator, external fixator index, radiographic consolidation index, complication, and total cost for treatment was also recorded. A modified classification of the Association for the Study and Application of the Method of Ilizarov (ASAMI) was used to assess results in two groups of patients; another SF-36 health survey questionnaire was used to assess the life qualities patients of two groups. RESULTS Healing was achieved in 13/13 and 13/15 of the two groups, respectively. The rates of complications were significantly higher in the group A. Two patients performed amputations because of persistent deep infections in group B. Statistically significant difference was found when comparing ASAMI scores and categories of the SF-36 health survey. CONCLUSIONS Bone transport by monolateral external fixator with the use of intramedullary nail reduces the incidence of complication and the duration of external fixator time that give patients a better life quality in both physical and emotional. However, if chronic osteitis exists, bone transport should be treated with monolateral external fixator alone due to a lower rate of amputations.
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Affiliation(s)
- Jun Wan
- Department of Orthopaedics, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, 410007, Hunan, People's Republic of China.
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Papanna MC, Monga P, Al-Hadithy N, Wilkes RA. Promises and difficulties with the use of femoral intra-medullary lengthening nails to treat limb length discrepancies. Acta Orthop Belg 2011; 77:788-794. [PMID: 22308625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Limb lengthening using external fixation may be associated with problems such as pin-track infections, poor patient acceptance, muscle transfixation, secondary axial deformity and re-fractures. Intramedullary lengthening nails have been designed to address these issues. We present our results for femoral limb lengthening in adults managed by intramedullary lengthening nails. A retrospective review was undertaken for 8 femoral lengthening procedures performed in adults using intra-medullary lengthening nails over a three-year period. The average age of our patients was 34 years; the average duration of follow-up was 26.5 months (range: 8 to 40 months). An Albizzia nail was used in 5 procedures, an Intra-medullary Skeletal Kinetic Distractor (ISKD nail) in 3 procedures. Target lengthening was achieved in 6 out of 8 femurs with an average of 38.77 mm (range: 0 to 70 mm) length gained. The distraction index (length gained per day) was 0.58 on average (range: 0-1.25) and the consolidation index average was 5039 (range: 0-79) days/cm. Premature consolidation was noted in 4 cases, runaway acute lengthening in one patient; prominent metalwork--noted in 4 patients--and a bent nail were frequent obstacles and meant multiple visits to theatre. Femoral lengthening with an intramedullary lengthening nail is a reasonable alternative to external fixators, thereby avoiding problems associated with callotasis using external fixation methods. It is however, important to counsel patients regarding possibilities of significant obstacles including failure and multiple visits to theatre during the process.
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Intema F, Van Roermund PM, Marijnissen ACA, Cotofana S, Eckstein F, Castelein RM, Bijlsma JWJ, Mastbergen SC, Lafeber FPJG. Tissue structure modification in knee osteoarthritis by use of joint distraction: an open 1-year pilot study. Ann Rheum Dis 2011; 70:1441-6. [PMID: 21565898 PMCID: PMC3128325 DOI: 10.1136/ard.2010.142364] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Modification of joint tissue damage is challenging in late-stage osteoarthritis (OA). Few options are available for treating end-stage knee OA other than joint replacement. Objectives To examine whether joint distraction can effectively modify knee joint tissue damage and has the potential to delay prosthesis surgery. Methods 20 patients (<60 years) with tibiofemoral OA were treated surgically using joint distraction. Distraction (∼5 mm) was applied for 2 months using an external fixation frame. Tissue structure modification at 1 year of follow-up was evaluated radiographically (joint space width (JSW)), by MRI (segmentation of cartilage morphology) and by biochemical markers of collagen type II turnover, with operators blinded to time points. Clinical improvement was evaluated by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Visual Analogue Scale (VAS) pain score. Results Radiography demonstrated an increase in mean and minimum JSW (2.7 to 3.6 mm and 1.0 to 1.9 mm; p<0.05 and <0.01). MRI revealed an increase in cartilage thickness (2.4 to 3.0 mm; p<0.001) and a decrease of denuded bone areas (22% to 5%; p<0.001). Collagen type II levels showed a trend towards increased synthesis (+103%; p<0.06) and decreased breakdown (−11%; p<0.08). The WOMAC index increased from 45 to 77 points, and VAS pain decreased from 73 to 31 mm (both p<0.001). Conclusions Joint distraction can induce tissue structure modification in knee OA and could result in clinical benefit. No current treatment is able to induce such changes. Larger, longer and randomised studies on joint distraction are warranted.
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Affiliation(s)
- Femke Intema
- Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
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Kenawey M, Krettek C, Liodakis E, Meller R, Hankemeier S. Insufficient bone regenerate after intramedullary femoral lengthening: risk factors and classification system. Clin Orthop Relat Res 2011; 469:264-73. [PMID: 20361281 PMCID: PMC3008908 DOI: 10.1007/s11999-010-1332-6] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2009] [Accepted: 03/17/2010] [Indexed: 01/31/2023]
Abstract
BACKGROUND Control of distraction rate with an intramedullary skeletal kinetic distractor (ISKD) may be problematic and a high distraction rate may result in insufficient bone regenerate. QUESTIONS/PURPOSES Are distraction problems preventable when using the ISKD, and what are the risk factors for and radiologic types of insufficient bone regenerate during ISKD lengthening? PATIENTS AND METHODS We analyzed 37 consecutive ISKD femoral lengthening procedures in 35 patients with a mean age 33 ± 11 years and minimum followup of 12 months (average, 27 ± 9 months; range, 12-55 months). The average length gain was 42.8 ± 12.9 mm. RESULTS Eight patients had problems during distraction: seven had "runaway nails" and one had a nondistracting nail. Insufficient bone regenerate developed in eight patients. Important risk factors were a distraction rate greater than 1.5 mm/day (9.1 times higher risk), age 30 years or older, smoking, and lengthening greater than 4 cm. Less important risk factors identified were creation of the osteotomy at the site of previous trauma or surgery and acute correction of associated deformities. We proposed a radiologic classification for failure of bone regeneration: partial regenerate failure (Type I) or complete failure resulting in a segmental defect subdivided according to a length of 3 cm or less (Type IIa) or greater than 3 cm (Type IIb). CONCLUSIONS Distraction problems with the ISKD were related mostly to internal malfunction of the lengthening mechanism. A distraction rate greater than 1.5 mm/day should be avoided in femoral intramedullary lengthening. Smoking should be a contraindication for femoral lengthening. LEVEL OF EVIDENCE Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Mohamed Kenawey
- Trauma Department, Hannover Medical School, Carl-Neuberg-Str 1, 30625 Hannover, Germany.
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Keinprasit C, Danthumrongkul S, Chengsuntisuk T, Nuntanaranont T. Distraction osteogenesis treatment of maxillary deficiency for cleft patient using internal distraction device: a case report. J Med Assoc Thai 2010; 93 Suppl 4:S83-S90. [PMID: 21302392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A case of severe maxillary hypoplasia in a 21 years old male Thai patient with a complete unilateral cleft of primary and secondary palates treated by internal distraction osteogenesis for maxillary advancement is presented. Initial evaluation showed Class III malocclusion with total crossbite and Class III skeletal malrelationship. Two intraoral distractors were placed following a Le Fort I osteotomy. A maxillary advancement of 8 mms was obtained with 1 mm overjet. Following distraction, Class III elastics were used to increase the overjet until an overjet of 3 mms was obtained. Both acceptable skeletal and soft tissue relationships and satisfactory occlusion have been produced. After 20 months of postoperative follow-up, the occlusal result is stable and skeletal relapse can not be detected.
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Affiliation(s)
- Chutimaporn Keinprasit
- Department of Orthodontics, Faculty of Dentistry, Khon Kaen University, Khon Kaen, Thailand.
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Laudemann K, Petruchin O, Nafzger M, Ballon A, Kopp S, Sader RA, Landes CA. Long-term 3D cast model study: bone-borne vs. tooth-borne surgically assisted rapid maxillary expansion due to secondary variables. Oral Maxillofac Surg 2010; 14:105-114. [PMID: 20108107 DOI: 10.1007/s10006-009-0194-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE This study aims to compare bone-borne (BB) surgically assisted rapid maxillary expansion (SARME) to tooth-borne (TB) SARME with regard to dentoskeletal effects. PATIENTS AND METHODS Measurements were performed on 3D scanned cast models of 34 patients preoperatively and 20.5 +/- 1.34 months post-expansion. Secondary variables were pterygomaxillary disjunction or not; bimaxillary osteotomy or not and patient age. RESULTS BB SARME without pterygomaxillary disjunction on patients <20 years led to a symmetric increase in transverse widening; however, simultaneously, to more dental tipping (canines/second molars) and to the biggest overall attachment loss (frontal teeth/premolars), especially, after the performance of bimaxillary osteotomy. TB SARME led to an asymmetric decrease in transverse widening and to more dental tipping (premolars/first molars). CONCLUSION In long-term effects, BB SARME led to a symmetric increase in transverse widening; however, at the price of frontal attachment loss, resulting from the initial asymmetric, but bigger, overall transverse widening, the initial major segmental rotation and the necessary orthodontics for tooth arch alignment before and after bimaxillary osteotomy.
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Affiliation(s)
- Katharina Laudemann
- Oral-, Maxillofacial and Plastic Facial Surgery, Goethe University Frankfurt, Frankfurt, Germany.
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Chossegros C. [The Editor's award]. Rev Stomatol Chir Maxillofac 2009; 110:316-317. [PMID: 19931882 DOI: 10.1016/j.stomax.2009.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2009] [Accepted: 10/18/2009] [Indexed: 05/28/2023]
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Kumar PS, Saxena R, Patil S, Keluskar KM, Nagaraj K, Kotrashetti SM. Clinical investigation of periodontal ligament distraction osteogenesis for rapid orthodontic canine retraction. Aust Orthod J 2009; 25:147-152. [PMID: 20043550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
AIMS To investigate rapid canine distalisation by periodontal ligament distraction and to determine the effects of periodontal ligament distraction on the canine root and pulpal vitality. METHODS The sample consisted of 16 upper canines in eight patients who required first premolar extractions. The upper first premolars were extracted and the interseptal bone distal to each canine was thinned and undermined surgically. Custom-built distractors were placed and activated immediately to distract the canines into the extraction spaces. Radiographs were taken before canine distraction and at regular intervals thereafter. The upper canine pulps were tested with an electronic pulp tester before and after the distraction and the canines were examined on the post-distraction radiographs for evidence of apical and lateral root resorption. RESULTS The canines were retracted to proximal contact with the second premolars in 20.33 +/- 1.87 days. The average amount of retraction was 5.25 mm and the canines tipped distally 15.33 degrees. Although the upper molars did not move mesially, they extruded almost 1 mm. Root resorption was minimal and there was no deterioration in pulp vitality. CONCLUSION Canines can be rapidly retracted by periodontal ligament distraction without complications. However, the efficacy of the method depends upon the surgical procedure, which is technique sensitive. Resistance offered by the interseptal bone distal to the apex of the canine was thought to be the reason for the canine tipping during distraction.
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Affiliation(s)
- Priyanka Sethi Kumar
- Department of Orthodontics and Dentofacial Orthopedics, Santosh Dental College and Hospital, Ghaziabad, India.
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Kilic E, Kilic K, Alkan A. Alternative method to reposition the dislocated transport segment during vertical alveolar distraction. J Oral Maxillofac Surg 2009; 67:2306-10. [PMID: 19761927 DOI: 10.1016/j.joms.2009.04.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2008] [Revised: 01/17/2009] [Accepted: 04/19/2009] [Indexed: 11/20/2022]
Affiliation(s)
- Erdem Kilic
- Department of Oral and Maxillofacial Surgery, Erciyes University Faculty of Dentistry, Kayseri, Turkey.
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Lambiris E, Papadopoulos A, Karabasi A, Karageorgos A. Secondary intramedullary nailing after distraction osteogenesis30 patients followed for 2–12 years. ACTA ACUST UNITED AC 2009; 75:481-6. [PMID: 15370595 DOI: 10.1080/00016470410001286-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND There is no consensus about replacement of an external fixator by reamed intramedullary nailing in fracture cases. PATIENTS AND METHODS We evaluated the outcome in 30 patients (33 segments) of secondary intramedullary nailing during the consolidation phase after callus distraction using an external device. The main reasons for nailing were docking site nonunion (17 patients), angular deformity or fracture of the lengthened area (8 patients) or intolerance of the external device (5 patients), in 11 patients combined with a delayed distracted callus maturation. The average follow-up time was 4 (2-12) years. RESULTS Intramedullary infection after nailing occurred in 1 case, and slight loss in callus length in 5 cases. Failure of union at the docking site with nail breakage occurred in 1 case. In the other patients, consolidation in the lengthened callus area and also union at the docking site were achieved on average 6 months after nailing. INTERPRETATION We believe that intramedullary nailing during the consolidation phase after bone lengthening or bone transport is a treatment option for delayed callus maturation or docking site nonunion, reducing prolonged use of the external fixator.
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Affiliation(s)
- Elias Lambiris
- Department of Orthopaedic Surgery, Patras University Medical Center, Rio-Patras, Greece
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Abstract
BACKGROUND AND PURPOSE Distraction osteogenesis may be used for the treatment of brachymetatarsia. However, few reports have been published on first metatarsal lengthening by this method. We evaluated the complications of distraction osteogenesis for first brachymetatarsia and here we provide a solution. PATIENTS AND METHODS 16 patients (27 feet) underwent distraction osteogenesis for first brachymetatarsia. Mean age at time of surgery was 20 (12-34) years and mean duration of postoperative follow-up was 5 (2-13) years. A unilateral external fixator was fixed at the medial aspect of the metatarsus. The distraction axis was parallel to the plantar surface of the foot in the sagittal plane and to the second metatarsal axis in the transversal plane. RESULTS First metatarsal length expressed as a proportion of second metatarsal length was 60% (55-64). Average degree of metatarsal lengthening was 42% (34-54), and the average lengthening index was 64 (39-93) days/cm. The most common complication was stiffness of the metatarsophalangeal joint (12 feet). Deformities that included cavus foot and hallux valgus occurred in 3 feet each, and callus fractures occurred in 3 feet. The other complications were pin breakage and pin tract infection in 2 feet each. INTERPRETATION Distraction osteogenesis for first brachymetatarsia can give satisfactory cosmetic and functional results. However, several complications are commonly encountered. This report on complications and their solutions may help those attempting distraction osteogenesis for first brachymetatarsia.
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Affiliation(s)
- Keun-Bae Lee
- Department of Orthopaedics, Chonnam National University Medical School and Hospital, Gwangju, South Korea.
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Hopper RA, Aspinall C, Heike C, Andrews M, Sittler B, Saltzman B, Ose M. What the patients and parents do not tell you-recollections from families following external LeFort III midface distraction. Plast Surg Nurs 2009; 29:78-87. [PMID: 19528775 DOI: 10.1097/01.psn.0000356865.16435.6f] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE The purpose of this study was to document the experience of patients and parents of patients who had recently undergone LeFort III midface distraction using an external halo-based device. DESIGN Cross-sectional study. SETTING A craniofacial center in a pediatric tertiary care medical center. SUBJECTS Eight children who had undergone midface distraction within 1 year of the interview and their caregivers. INTERVENTION Semi-structured interview. MAIN OUTCOME MEASURE Transcripts of the interviews were rendered anonymous and analyzed by our multi-disciplinary team. Consistent themes in the subjects' experience during and after midface distraction were identified. RESULTS (1) Family participation in the decision to undergo distraction and pre-operative preparation was recognized as valuable, but parents identified that there are inherent limitations; (2) home-care tasks seemed daunting pre-operatively but were easier than expected; (3) discomfort, sleeping, and interaction with peers were considered well accommodated, but feeding was challenging; (4) individualized pre-operative plans for community support was important; (5) parents and patients were impressed by the change in appearance, specifically in the peri-orbital region; (6) access to team members and to parents of patients who had participated in the distraction process was invaluable. CONCLUSION External midface distraction is a valuable clinical technique, but requires intensive preparation and support from a multi-disciplinary team. We provide suggestions for consideration by centers initiating and refining patient care plans for this surgery.
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Affiliation(s)
- Richard A Hopper
- Children's Craniofacial Center, Seattle Children's Hospital, Seattle, Washington 98105, USA
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Antoci V, Ono CM, Antoci V, Raney EM. Pin-tract infection during limb lengthening using external fixation. Am J Orthop (Belle Mead NJ) 2008; 37:E150-E154. [PMID: 18982187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We evaluated the incidence of pin-tract infection (PTI) during limb lengthening using external fixation in 88 patients and the effects of infection on final outcomes and incidence of additional procedures. The PTI rate was 96.6%. The rate of half-pin site infection was significantly (P<.05) higher in half-pin fixators (100%) than in hybrid fixators (78%). There was a significantly (P<.05) higher incidence of half-pin site infection (78%) than fine-wire site infection (33%). The rate of additional surgeries for treating PTI was higher for half-pin sites than for fine-wire sites. Three (3.4%) of the 88 cases led to chronic osteomyelitis. Careful insertion and a simple, well-defined, excellent pin-care protocol can minimize PTI.
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Affiliation(s)
- Valentin Antoci
- Department of Orthopaedic Surgery and Rehabilitation, Texas Tech University, Health Sciences Center, Paul L. Foster School of Medicine, El Paso, Texas, USA.
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