• 제목/요약/키워드: mandible distraction osteogenesis

검색결과 60건 처리시간 0.038초

Vertical distraction osteogenesis of a reconstructed mandible with a free vascularized fibula flap: a report of two cases

  • Saito, Naoaki;Funayama, Akinori;Arai, Yoshiaki;Suda, Daisuke;Takata, Yoshiyuki;Kobayashi, Tadaharu
    • Maxillofacial Plastic and Reconstructive Surgery
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    • 제40권
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    • pp.32.1-32.8
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    • 2018
  • Background: The free vascularized fibula flap presents many advantages such as sufficient length of the bony segment, good vascularization, better quality of the bone, and a long vascular pedicle, but it is also associated with some disadvantages with regard to prosthetic rehabilitation because of its limited height. Improvement in bone height is necessary for ideal dental implant treatment of reconstructed mandibles. Case presentation: For two squamous cell carcinoma patients, mandibular bone reconstruction was performed secondarily with the peroneal flap after tumor resection. Since the bone height was insufficient at the time of implant treatment, occlusion reconstruction by dental implant was performed after vertical distraction osteogenesis. Conclusions: Vertical distraction osteogenesis is a suitable treatment option for alveolar ridge deficiency resulting from fibula transplantation for mandibular reconstruction following tumor surgery.

A New Method of Synchronous Distraction Osteogenesis of the Maxilla and Mandible

  • 정필훈;강영호;서병무
    • 대한구순구개열학회지
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    • 제5권2호
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    • pp.113-116
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    • 2002
  • 편측 왜소증의 얼굴을 상하악과 하악 모두 신장할 필요가 있는 경우 하악을 신장하여 상악도 신장시키는 방법을 최근 소개한 바 있으나 본 논문에서는 오히려 상악을 신장시킬 때 하악도 같이 신장시키는 방법을 개발하여 좋은 결과를 얻었다. 두 명의 편측안면 왜소증 환자에서 양악 동시에 골 신장술을 시행하였다. Ortiz Monasterio의 방법과 달리 상악은 구내 르포트씨 제일 골절단술을 시행하였고, 하악은 구내 시상분할 골 절단술을 이용하여 골신장시 저항을 최소한으로 줄이려 하였다. 편방향 구내 골 신장기와 스플린트를 이용하여 양악 골신장술을 시행하였다. 5일의 잠재기 후 매일 1mm의 골신장을 시행하였고 6주에서 8주간의 경화기를 둔 후, 골 신장기와 스플린트를 제거하였다. 골신장 길이는 각각 13mm와 15mm이었고, 특이할 만한 부작용은 관찰되지 않았다. 이에 본 교실에서는 상악신장을 바탕으로 양악을 신장시키는 새로운 술식을 보고하는 바이다.

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가토에서 하악골 신연 6주후 신연양에 따른 두개하악관절의 조직병리학적 변화 (HISTOPATHOLOGIC CHANGES OF THE CRANIOMANDIBULAR JOINT ACCORDING TO THE AMOUNT OF DISTRACTION AFTER 6 WEEKS OF DISTRACTION OSTEOGENESIS IN RABBITS)

  • 김현호;김수관;임성철;정해만;김생곤
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • 제29권2호
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    • pp.79-85
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    • 2003
  • The purpose of this study is to observe histopathologic changes in the bilateral craniomandibular joints after allowing 6 weeks of consolidation by varying the amount of distraction in rabbit mandible. Eight rabbits weighing about 2 to 3 kg were used. After corticotomy was performed on the left mandibular body between the first premolar and the second premolar region, a unilateral fixation device was placed. Then, a 7-day period was allowed without distraction of the device. The mandible was lengthened 0.5 mm/day. Corticotomy and lengthening of mandible were not performed in control group. After the completion of the lengthening process, a 6-week-consolidation period was allowed. Then, the rabbits were sacrificed, and histologic examination of the craniomandibular joints was performed. Proliferative changes were observed in the craniomandibular joints in all groups. With the increasing amount of distraction, hypertrophy of the cartilage layer became more severe, bone formed was dense and enchondral ossification was clearly shown in subchondral bone. Hypertrophy of the cartilage layer was also seen in the non-distracted side as the distracted side in the experimental group. These results indicate that when physical force is applied constantly to joints, the proliferation of articular cartilage and bone formation are present. When more than 6 weeks of consolidation period is allowed at the time of performing distraction for more than 5 mm, articular changes, especially, in the contralateral side should also be noted.

가토에서 하악골 신연 양에 따른 하치조신경의 조직학적 변화 (HISTOLOGIC CHANGES OF THE INFERIOR ALVEOLAR NERVE ACCORDING TO THE AMOUNT OF THE MANDIBULAR LENGTHENING IN RABBITS)

  • 김기영;유선열
    • Maxillofacial Plastic and Reconstructive Surgery
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    • 제20권3호
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    • pp.250-255
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    • 1998
  • The purpose of this study was to evaluate the histologic change of the inferior alveolar nerve according to distraction amount following mandibular lengthening. Seven rabbits weighing about 2 kg were used. Corticotomy was performed on the mandibular body anterior to the right first premolar region and unilateral external fixation device was placed. Every effort was made to preserve the inferior alveolar nerve during the corticotomy. The rabbits were then allowed to heal for 7 days without distraction of the device. The mandible was lengthened 0.36 mm/day, 0.76 mm/day, or 1.0 mm/day. Corticotomy and lengthening of mandible were not performed in control group. After the completion of the lengthening process, a 14-day-consolidation period was allowed. After consolidation, rabbits were sacrificed, and histologic examination of the inferior alveolar nerve was performed. The results obtained were as follows : 1. In the control group, normal trifascicular pattern of inferior alveolar nerve was observed. Epineurium, perineurium, endoneurium, and axon with myelin sheath were observed in normal appearance. 2. In 0.36 mm/day distraction group, the trifascicular pattern was normally shown, and there was no destruction in epineurium, perineurium, and endoneurium. The mild changes including myelin attenuation, axoplasmic swelling and darkening were observed. 3. In 0.72 mm/day distraction group, it was possible to differentiate the epineurium from the perineurium. Two normal fascicles and one injuried fascicle were observed with a partially destructed perineurium. Most of the axons had axoplasmic swelling and darkening. 4. In 1 mm/day distraction group, it was difficult to differentiate the nerve structures such as fascicles, epineurium, perineurium, and endoneurium. The axons were severely destroyed, except few which showed decreases in size and changes in shape. Some collagen matrices were observed around the axons. These results suggest that the higher the distraction amount, the more severe the injury to the inferior alveolar nerve, fascicles, axons. Although distraction osteogenesis may be useful, the amount of distraction should be carefully selected.

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하악골 재건시 사용된 유리비골피판에서 임플란트 식립을 위한 수직적 골신장술 (VERTICAL DISTRACTION OSTEOGENESIS FOR IMPLANT INSTALLATION ON THE RECONSTRUCTED MANDIBLE WITH FREE FIBULAR FLAP)

  • 팽준영;이진용;명훈;황순정;서병무;최진영;이종호;정필훈;김명진
    • Maxillofacial Plastic and Reconstructive Surgery
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    • 제28권6호
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    • pp.579-585
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    • 2006
  • Introduction: The fibular free flap is now considered as the first choice for long mandibular discontinuity defect. In spite of its good bone quality for implant installation, its diameter is too narrow to rehabilitate the masticatory function with implant installation. In this report, distraction osteogenesis was used for the augmentation of bone to install the dental implant in the mandible which was reconstructed with a vascularized fibular free flap. Patients and Methods: Three patients undertook the vertical augmentation of grafted fibular bone and dental implants were installed. On the day 8 post-surgery, the activation of the distractor was started at the rate of 1 mm twice a day. The total amount of distraction was 15 mm in two patients and 12.5 mm in one patient. Twelve implants were installed in three patients. Dental implants were simultaneously installed during removal of the distraction device in two patients. In one patient, the implant installation was delayed after device had been removed. All three patients showed the symptoms of mild to severe postoperative infection during the activation and consolidation. However, the distracted site showed undisturbed bone regeneration. Conclusion: The distraction osteogenesis showed the reliable results for the vertical augmentation of fibular bone which was used for the mandibular reconstruction. However, the great tendency of postoperative infection must be considered and clinically controlled.

Sequential treatment for a patient with hemifacial microsomia: 10 year-long term follow up

  • Seo, Jeong-Seok;Roh, Young-Chea;Song, Jae-Min;Song, Won-Wook;Seong, Hwa-Sik;Kim, Si-Yeob;Hwang, Dae-Seok;Kim, Uk-Kyu
    • Maxillofacial Plastic and Reconstructive Surgery
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    • 제37권
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    • pp.3.1-3.7
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    • 2015
  • Hemifacial microsomia (HFM) is the most common craniofacial anomaly after cleft lip and cleft palate; this deformity primarily involves the facial skeleton and ear, with either underdevelopment or absence of both components. In patients with HFM, the management of the asymmetries requires a series of treatment phases that focus on their interception and correction, such as distraction osteogenesis or functional appliance treatment during growth and presurgical orthodontic treatment followed by mandibular and maxillary surgery. Satisfactory results were obtained in a 9-year-old girl with HFM who was treated with distraction osteogenesis. At the age of 19, genioplasty and mandible body augmentation with a porous polyethylene implant (PPE, $Medpor^{(R)}$, Porex) was sequentially performed for the functional and esthetic reconstruction of the face. We report a case of HFM with a review of the literature.

A case report about the reconstruction procedures of the previously failed cylinderical implants site using distraction osteogenesis

  • Lee, Jung-Tae;Park, Shin-Young;Yi, Yang-Jin;Kim, Young-Kyun;Lee, Hyo-Jung
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • 제41권2호
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    • pp.84-89
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    • 2015
  • We report the eventually successful treatment of a huge bone defect and peri-implantitis following reconstruction of a previously failed intra-mobile cylinder implant system (IMZ) implant site using distraction osteogenesis (DO). In the anterior mandible, two IMZ implants failed and surgical debridement was performed in accordance to the patient's needs. Thereafter, mobility and suppuration were decreased and the patient visited the dental clinic on a regular basis for oral health maintenance. However, the inflammation did not resolve, and the bone destruction around the implants progressed for 4 years. Finally, the implants failed and a severe bone defect remained after implant removal. To reconstruct the bone defects, we attempted bone graft procedures. Titanium mesh was unsuccessfully used to obtain bone volume regeneration. However, DO subsequently was used to obtain sufficient bone volume for implant placement. The new implants were then installed, followed by prosthetic procedures. In conclusion, progression of peri-implantitis could not be arrested despite surgical intervention and repeated maintenance care for 3 years. Reconstruction of the peri-implantitis site was complicated due to its horizontal and vertical bone defects. Lesions caused by implant failure require an aggressive regenerative strategy, such as DO. DO was successful in reconstruction of a peri-implantitis site that was complicated due to horizontal and vertical bone defects.

압축력을 병용한 하악골 신장술 (MANDIBULAR DISTRACTION OSTEOGENESIS WITH COMPRESSION FORCE - BONE DENSITY, HISTOLOGICAL FINDINGS AND TMJ RESPONSE)

  • 황영섭;허준;김욱규;박성진;황대석;김용덕;정인교;김규천
    • Maxillofacial Plastic and Reconstructive Surgery
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    • 제28권6호
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    • pp.531-548
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    • 2006
  • The purpose of this study was to investigate the biomechanical, histologic findings of distracted regenerate and TMJ response in modified distraction osteogenesis (DO) technique combined with compression force as biomechanical stimulation method which has been suggested in 2002, and developed thereafter by authors. This study was performed with two experiments. First experiment was designed to explore the optimal ratio of compression force versus distraction force for the new DO technique. Second experiment was planned to evaluate the reaction of TMJ tissue, especially condyle, disc after application of the DO technique with compression force. Total 52 New Zealand adult male-rabbits with 3.0kg body weight were used for the study. For the first study, 30 adult male-rabbits underwent osteotomy at one side of mandibular body and a external distraction device was applied on each rabbit with same manner. In the control group of 10 rabbits, final 8 mm of distraction with 1 mm rate per day was done with conventional DO technique after 5 latency days. For the experimental group of 20 rabbits, a compression force with 1 mm rate per day was added to the distracted mandible on 3-latency day after over-distraction (over-lengthening). As the amount of the rate of compression versus distraction, experimental subgroup I (10 rabbits) was set up as 2 mm compression versus 10 mm distraction (1/5) and experimental subgroup II (10 rabbits) was set up as 3 mm compression versus 11 mm distraction (about 1/3). All 30 rabbits were set up to obtain final 8 mm distraction and sacrificed on postoperative 55 day to analysis on biomechanical, and histologic findings of the bone regenerates. For second study, 22 adult male-rabbits were used to evaluate TMJ response after the DO method application with compression force. In the control group, 10 rabbits was used to be performed with conventional DO method, on the other hand, in a experimental group of 10 rabbits, 10 mm distraction with 2 mm compression (1/5 ratio) was done. The remaining 2 rabbits served as the normal control group. Histomorphologic examinations on both condyle, histological studies on condyle, disc were done at 1, 2, 3, 4, 7 weeks after distraction force application. The results were as follows: 1. On the bone density findings, the experimental group II (force ratio - 1/3) showed higher bone density than the other experimental group (force ratio - 1/5) and control group (control group - $0,2906\;g/cm^2$, experimental group I - $0.2961\;g/cm^2$, experimental group II - $0.3328\;g/cm^2$). 2. In the histologic findings, more rapid bone maturation like as wide lamellar bone site, more trabeculae formation was observed in two experimental groups compared to the conventional DO control group. 3. In morphologic findings of condyle, there were no differences of size and architecture in the condyle in the control and experimental groups. 4. In histologic findings of condyles, there were thicker fiberous and proliferative layers in experimental group than those of control group until 2 weeks after distraction with compression force. But, no differences were seen between two groups on 3, 4, 7 weeks after compression. 5. In histologic findings of disc, more collagen contents in extracellular matrix, more regular fiber bundles, and less elastin fibers were seen in experimental group than control group until 2 weeks after distraction with compression. But, no differences were seen between two groups on 3, 4, 7 weeks after distraction with compression. From this study, we could identify that the new distraction osteogenesis technique with compression stimulation might improve the quality of bone regeneration. The no remarkable differences on TMJ response between control and experimental groups were seen and TMJ tissues were recovered similarly to normal TMJ condition after 3 weeks.

어려운 기관 내 삽관이 예상되는 환자의 기도관리 -증례 보고- (Airway Management in the Patients of Expected Difficult Intubation -A Case Report-)

  • 오세리;이진한
    • 대한치과마취과학회지
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    • 제10권2호
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    • pp.190-196
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    • 2010
  • Difficult airway management including difficult intubation, difficult ventilation and difficult mask ventilation is a life threatening issue during anesthesia care. A 23-year-old woman with Treacher Collins syndrome was scheduled for distraction osteogenesis. She had hypoplasia of mandible and malar bone, bilateral deformities of auricles with partial deafness and antimongoloid slant of the palpebral fissures. A 56-year-old woman with mandibular hypoplasia due to childhood trauma was scheduled for distraction osteogenesis. She had a history of difficult intubation. We anticipated a difficult intubation and ventilation. Fiberoptic bronchoscopic guided awake intubation was selected for anesthesia induction. After intravenous injection of midazolam and remifentanil, 10% lidocaine pump spray on the pharyngolarynx with a direct laryngoscope and on the nasal canal. However fiberoptic bronchoscopic guided awake intubation was failed due to severe gag reflex. After intravenous injection of propofol and remifentanil using the target controlled infusion (TCI), mask ventilation was easily performed and, after intravenous injection of vecuronium, fiberoptic bronchoscopic guided intubation was easily performed using a wire reinforced endotracheal tube. The operation was completed successfully without any adverse events.

골신장술시 반복적인 압축과 신장 방법이 골형성에 미치는 영향 (THE EFFECT OF REPETITIVE DISTRACTION AND COMPRESSION ON NEW BONE FORMATION DURING DISTRACTION)

  • 윤병욱;김여갑;오정환
    • Maxillofacial Plastic and Reconstructive Surgery
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    • 제30권5호
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    • pp.407-416
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    • 2008
  • Purpose: The aim of the present study is to evaluate the effect of repetitive distraction and compression on new bone formation during distraction period. Materials and methods: Sixteen healthy rabbits, weighing about 2.5kg, were used in this experiment. A unilateral mandibular osteotomy was performed in the left mandible and the distractor(Track 1 $plus^{(R)}$, Gebruder Martin $GmbH^{(R)}$, Germany) was fixed with four screws (Cross driver screw $TI^{(R)}$, Gebruder Martin $GmbH^{(R)}$, Germany). After 4 days, the mandibles were distracted at a rate of 0.6mm/day for 10 days to obtain the amount of 6mm distraction in the control group(n=4). In the experimental group A(n=6), they were distracted at a rate of 1.2mm/day for 5 days and then compression of 0.6mm length and distraction of 0.6mm per 12 hours were carried out as counter direction for 5 days, relatively. In the experimental group B(n=6), distraction of 1.2mm length and compression of 0.6mm length per 12 hours were repeated for 10 days to obtain the amount of 6mm distraction finally. The experimental animals were sacrificed at 2 and 4 weeks after surgery and block specimens were obtained. With histologic and histomorphometric analysis, we observed the histologic changes of the cells and bone formation after H-E and Masson- Trichrome staining and then, measured Bone Deposition Rate with TOMORO $ScopeEye^{TM}$ ver. 3.5(Olympus, Japan), Results: Histologically, new bone formation was examined in all experimental groups and the control. But, the ability of bone formation of the experimental group A was somewhat better than any other groups. On the histomorphometric analysis, Bone Deposition Rate was higher in the experimental group A$(50.67{\pm}4.36%)$ than in the control group$(45.94{\pm}3.97%)$ and in the experimental group B$(42.68{\pm}5.70%)$. These data showed significant differences statistically(p<0.05). Conclusion: These results show that the distraction osteogenesis using repetitive compression and distraction force in the early consolidation period may be effective for new bone formation.