Atlanta Oral & Facial Surgery

Distraction Osteogenesis Case Studies

Case 1

Case 1: Alveolar Distraction

      The patient, E.S., is a healthy 24-year-old female who had a central giant cell granuloma removed in December 1998. She has recovered well and is currently 15 months disease free. She is now prepared for reconstruction of her mandibular alveolus using distraction osteogenesis.

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24 Year Old Female
 
A. Pre Op Xray
 
B.Three-D Stereolithic Model
 
C. Surgical Osteotomy
 
D. LEAD™ distraction device
 
E. One Month After Surgery
 
F. Implants Placed
 
G. Implants Restored
 

      Patient ES had her distraction device activated 1mm per day until sufficient alveolar height was achieved. The distraction rod was removed 4 weeks later. Implants were placed 4 months after the initial surgery, then restored 5 months later.

Case 2

Case 2: Mandibular Advancement

      The patient, P.B., is a healthy 36-year-old female presenting with a diagnosis of mandibular retrognathia, microgenia and vertical maxillary excess. Treatment plan for this patient included:

  1. Maxillary Le Fort I osteotomy with impaction of the maxilla
  2. Bilateral ramus osteotomies and placement of bilateral distraction devices
  3. Genioplasty.

(Move mouse over images for a larger view.)

36 Year Old Female
 
A. Pre Op
 
B. Post Op
 
C. One Month After Surgery
 
D. Eight Months After Surgery
 

      The patient underwent the surgical procedure without event on May 8th and has recovered well from her surgery.

Case 3

Case 3: Mandibular Regeneration using Transport Disc Distraction Osteogenesis (TDDO)

      Our patient is a 25-year-old healthy female who initially presented to our office in August of 1997 regarding a large tumor in her right lower jaw. Biopsy of the tumor determined it to be a MYXOMA. The tumor was removed in September of 1997.

      In January of 1998 the patient’s lower jaw was reconstructed using an irradiated cadaver mandible and bone graft from her hip. This failed secondary to infection and in December of 1998 the entire graft was removed.

      In May of 2000 the patient was taken back to the operating room and while she was under general anesthesia part of the remaining lower jaw was cut to make a transport disc. This disc was then transported 30 mm using an intraoral distraction device developed by the Stryker-Leibinger Corporation (Phase I). Once the device had reached its limit the patient was taken back to the operating room and the transport disc was cut in half One half was secured to the reconstruction bar and the other half was affixed to the distraction device. This half was then transported another 30 mm (Phase ll).The remaining part of the patient’s lower jaw was reconstructed using a hip graft.

      The patient is currently 18 months post placement of implants and doing well. Restoration of the dental implants was done by Dr. Warren Bern of Woodstock, Georgia.

      If you have any additional questions about Distraction Osteogenesis you may contact Dr. Whitesides at drlwhitesides@atlantaoralsurgery.com or Dr. Wunderle at drrwunderle@atlantaoralsurgery.com.

      We would also like to express our deep appreciation to Dr. Cesar Guerrero of Caracas, Venezuela and Dr. Bill Bell of Dallas, Texas for the contributions in the treatment planning and care of this patient.

(Move mouse over images for a larger view.)

Tumor
 
Post Tumor Resection
 
Cadaver and Hip Bone Graft
 
Computer 3D image of lower
jaw detect after removal of graft
 
Reconstruction of lower jaw
using TDDO. Beginnig of Phase 1
 
Reconstruction of lower
jaw using TDDO. End of Phase I.
 
Jaw reconstruction using TDDO.
Beginning Phase II
 
Reconstruction of lower
jaw. End of Phase II.
 
Reconstructed lower jaw
with TDDO and hip graft.
 
Reconstrcuted Mandible
using TDDO.
 
Reconstrcuted lower jaw
using TDDO (view from above)
 
Panorex of Dental Implants
 
Clinical photo of patient's
current dentition.
 

Case 4

Case 4: Hemifacial Microsomia

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Patient before phase I surgery
 
Note the asymmetric bite
 
3D image of patient’s head
 
Panorex of patient’s jaws
before phase I surgery
 
Patient’s face after phase I
distraction surgery
 
Panorex of patient after
phase II distraction surgery
is complete (done 18
months after phase I)
 
Patient’s face after phase II
distraction surgery is complete
(done 18 months after phase I)
 

Case 5

Case 5: Hemifacial Microsomia

(Move mouse over images for a larger view.)

Patient’s face before surgery
 
Patient’s asymmetric bite
before surgery
 
3D image of patient’s
head & face
 
Panorex of patient’s jaws
with distraction device
in place
 
Patient’s face 18 months
after distraction surgery
 
Patient’s bite 18 months
after distraction surgery
(note asymmetry is absent)