Long-term outcomes of distraction osteogenesis in craniofacial reconstruction

Authors

  • Deepa Pande
  • Senthilnathan
  • Thennarasu A R
  • Silky bhargava
  • Nivashini Murugaraj
  • Rutvi V. Shah

Keywords:

Distraction osteogenesis, Craniofacial deformities, Midface hypoplasia, Mandibular deficiency, Pediatric reconstruction, Skeletal regeneration

Abstract

Distraction osteogenesis (DO) has become a new phenomenon in craniofacial reconstruction, especially in treating complex malformations like midface hypoplasia, mandibular deficiencies, and orbital malformations. Compared to conventional procedures that entail osteotomies and bone grafting, DO allows gradual lengthening of the skeleton and associated soft tissue adaptation, which minimizes donor site morbidity and improves stability. The method has been particularly effective in children, as it allows natural facial development and solves functional and cosmetic issues. DO is used clinically to treat syndromic craniosynostoses (e.g., Crouzon and Apert syndromes), Pierre Robin Sequence, and post-traumatic deformities. Despite its benefits, long-term observation shows problems of device complications, infections, asymmetry, and secondary surgery. Patient compliance and careful planning are key to successful results. This has been enhanced by the ongoing innovations in 3D virtual surgical planning and custom distractor design that have increased precision and lowered the rate of complications. Nonetheless, interdisciplinary management is indispensable to achieve long-lasting functional recovery and aesthetic balance of patients undergoing DO to correct craniofacial deformities

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

References

Mundinger GS, Rehim SA, Johnson O 3rd, Zhou J, Tong A, Wallner C, Dorafshar AH. Distraction Osteogenesis for Surgical Treatment of Craniosynostosis: A Systematic Review. Plast Reconstr Surg. 2016 Sep;138(3):657-669. doi: 10.1097/PRS.0000000000002475. PMID: 27127836.

Stricker G, Clifford E, Cohen LK, Giddon DB, Meskin LH, Evans CA. Psychosocial aspects of craniofacial disfigurement. A "State of the Art" assessment conducted by the Craniofacial Anomalies Program Branch, The National Institute of Dental Research. Am J Orthod. 1979 Oct;76(4):410-22. doi: 10.1016/0002-9416(79)90226-4. PMID: 386802.

Posnick, J. C. (2000). Craniofacial and maxillofacial surgery in children and young adults. W.B. Saunders.

Neovius E, Engstrand T. Craniofacial reconstruction with bone and biomaterials: review over the last 11 years. J Plast ReconstrAesthet Surg. 2010 Oct;63(10):1615-23. doi: 10.1016/j.bjps.2009.06.003. Epub 2009 Jul 3. PMID: 19577527.

Nickenig, J., Zöller, J. E., & Kreppel, M. (2023). Indications and surgical technique for distraction osteogenesis of the alveolar bone for augmentation prior to insertion of dental implants. Periodontology 2000, 93(1), 327-339. https://doi.org/10.1111/prd.12524

McCarthy JG, Schreiber J, Karp N, Thorne CH, Grayson BH. Lengthening the human mandible by gradual distraction. Plast Reconstr Surg. 1992 Jan;89(1):1-8; discussion 9-10. PMID: 1727238.

Ilizarov GA. The tension-stress effect on the genesis and growth of tissues: Part II. The influence of the rate and frequency of distraction. Clin Orthop Relat Res. 1989 Feb;(239):263-85. PMID: 2912628.

Adejuyigbe B, Gharpure M, Wahle CF, Kallini JR. Distraction Osteogenesis: A Comprehensive Review. Applied Biosciences. 2024; 3(4):503-516. https://doi.org/10.3390/applbiosci3040032

Gosain AK; Plastic Surgery Educational Foundation DATA Committee. Distraction osteogenesis of the craniofacial skeleton. Plast Reconstr Surg. 2001 Jan;107(1):278-80. doi: 10.1097/00006534-200101000-00050. PMID: 11176641.

Yu JC, Fearon J, Havlik RJ, Buchman SR, Polley JW. Distraction Osteogenesis of the Craniofacial Skeleton. Plast Reconstr Surg. 2004 Jul;114(1):1E-20E. doi: 10.1097/01.prs.0000128965.52013.95. PMID: 15220559.

Lucchese A, Gherlone EF, Asperio P, Baena RR. The distraction osteogenesis in midfacial hypoplasia. J Craniofac Surg. 2014 May;25(3):831-4. doi: 10.1097/SCS.0000000000000738. PMID: 24769612.

Cho BC, Kyung HM. Distraction osteogenesis of the hypoplastic midface using a rigid external distraction system: the results of a one- to six-year follow-up. Plast Reconstr Surg. 2006 Oct;118(5):1201-1212. doi: 10.1097/01.prs.0000243563.43421.0b. PMID: 17016191.

Shetye PR, Kapadia H, Grayson BH, McCarthy JG. A 10-year study of skeletal stability and growth of the midface following Le Fort III advancement in syndromic craniosynostosis. Plast Reconstr Surg. 2010 Sep;126(3):973-981. doi: 10.1097/PRS.0b013e3181e60502. PMID: 20463620.

Mofid MM, Manson PN, Robertson BC, Tufaro AP, Elias JJ, Vander Kolk CA. Craniofacial distraction osteogenesis: a review of 3278 cases. Plast Reconstr Surg. 2001 Oct;108(5):1103-14; discussion 1115-7. doi: 10.1097/00006534-200110000-00001. PMID: 11604605.

Payne SH, Brady CM, Mercury OA, Soldanska M, Hush SE, Xiang Y, Williams JK. Mandibular Distraction in Neonatal Pierre Robin Sequence: Is Immediate Extubation Both Feasible and Safe? Plast Reconstr Surg. 2022 Jun 1;149(6):1155e-1164e. doi: 10.1097/PRS.0000000000009141. Epub 2022 Apr 12. PMID: 35413037.

Denny A, Kalantarian B. Mandibular distraction in neonates: a strategy to avoid tracheostomy. Plast Reconstr Surg. 2002 Mar;109(3):896-904; discussion 905-6. doi: 10.1097/00006534-200203000-00011. PMID: 11884804.

Scott AR, Tibesar RJ, Lander TA, Sampson DE, Sidman JD. Mandibular distraction osteogenesis in infants younger than 3 months. Arch Facial Plast Surg. 2011 May-Jun;13(3):173-9. doi: 10.1001/archfacial.2010.114. Epub 2011 Jan 17. PMID: 21242420.

Swennen G, Schliephake H, Dempf R, Schierle H, Malevez C. Craniofacial distraction osteogenesis: a review of the literature: Part 1: clinical studies. Int J Oral Maxillofac Surg. 2001 Apr;30(2):89-103. doi: 10.1054/ijom.2000.0033. PMID: 11405458.

Gateno J, Teichgraeber JF, Xia JJ. Three-dimensional surgical planning for maxillary and midface distraction osteogenesis. J Craniofac Surg. 2003 Nov;14(6):833-9. doi: 10.1097/00001665-200311000-00004. PMID: 14600624.

Meazzini MC, Mazzoleni F, Gabriele C, Bozzetti A. Mandibular distraction osteogenesis in hemifacial microsomia: long-term follow-up. J Craniomaxillofac Surg. 2005 Dec;33(6):370-6. doi: 10.1016/j.jcms.2005.07.004. PMID: 16256360.

Tibesar RJ, Sidman JD. Mandibular distraction osteogenesis in the pediatric patient. Curr Opin Otolaryngol Head Neck Surg. 2008 Dec;16(6):548-54. doi: 10.1097/MOO.0b013e3283177f81. PMID: 19005326.

Zenha, H., Azevedo, L., Rios, L., Pereira, A., Pinto, A., Barroso, M. L., & Costa, H. (2012). Bilateral mandibular distraction osteogenesis in the neonate with pierre robin sequence and airway obstruction: a primary option. Craniomaxillofacial trauma & reconstruction, 5(1), 25–30. https://doi.org/10.1055/s-0031-1300960

Tsai, C. Y., Lee, Y. H., Wu, T. J., Lin, S. S., Lai, J. P., & Chang, Y. J. (2022). A Comparative Study of Skeletal and Dental Outcome between Transcutaneous External Maxillary Distraction Osteogenesis and Conventional Rigid External Device in Treating Cleft Lip and Palate Patients. Journal of personalized medicine, 12(7), 1062. https://doi.org/10.3390/jpm12071062

Burns, H. R., Wang, D. S., Abu-Ghname, A., & Dempsey, R. F. (2023). Craniofacial Distraction Osteogenesis. Seminars in plastic surgery, 37(4), 253–264. https://doi.org/10.1055/s-0043-1776298

Liu, Z., Yang, J., Zhou, C., Liu, Y., & Luo, E. (2022). A bibliometric analysis of research on craniomaxillofacial distraction osteogenesis from 2000 to 2021. Frontiers in surgery, 9, 932164. https://doi.org/10.3389/fsurg.2022.932164

Murakami T, Shigeki S. Pharmacotherapy for Keloids and Hypertrophic Scars. International Journal of Molecular Sciences. 2024; 25(9):4674. https://doi.org/10.3390/ijms25094674

Verlinden CR, van de Vijfeijken SE, Tuinzing DB, Jansma EP, Becking AG, Swennen GR. Complications of mandibular distraction osteogenesis for developmental deformities: a systematic review of the literature. Int J Oral Maxillofac Surg. 2015 Jan;44(1):44-9. doi: 10.1016/j.ijom.2014.09.007. Epub 2014 Oct 29. PMID: 25442740.

Lefebvre A, Barclay S. Psychosocial impact of craniofacial deformities before and after reconstructive surgery. Can J Psychiatry. 1982 Nov;27(7):579-84. doi: 10.1177/070674378202700712. PMID: 7172158.

Noel W, Bosc R, Jabbour S, Kechichian E, Hersant B, Meningaud JP. Smartphone-Based Patient Education in Plastic Surgery. Ann Plast Surg. 2017 Dec;79(6):529-531. doi: 10.1097/SAP.0000000000001241. PMID: 29053521.

Akai, T., Yamashita, M., Shiro, T., Hamada, S., Maruyama, K., Iizuka, H., &Kuroda, S. (2022). Long-term Outcomes of Non-syndromic and Syndromic Craniosynostosis: Analysis of Demographic, Morphologic, and Surgical Factors. Neurologia medico-chirurgica, 62(2), 57–64. https://doi.org/10.2176/nmc.oa.2021-0101

Figueroa AA, Polley JW, Friede H, Ko EW. Long-term skeletal stability after maxillary advancement with distraction osteogenesis using a rigid external distraction device in cleft maxillary deformities. Plast Reconstr Surg. 2004 Nov;114(6):1382-92; discussion 1393-4. doi: 10.1097/01.prs.0000138593.89303.1b. PMID: 15509923.

Ilizarov GA. The tension-stress effect on the genesis and growth of tissues. Part I. The influence of stability of fixation and soft-tissue preservation. Clin Orthop Relat Res. 1989 Jan;(238):249-81. PMID: 2910611.

Zuo KJ, Heinelt M, Ho ES, Forrest CR, Zuker RM, Borschel GH. Dynamic Reconstruction of Facial Paralysis in Craniofacial Microsomia. Plast Reconstr Surg. 2022 Apr 1;149(4):919-929. doi: 10.1097/PRS.0000000000008927. PMID: 35171871.

Turatti, G., Bruni, A., Savoini, M., Giordano, M., &Gerbino, G. (2019). Maxillomandibular Transverse Osteodistraction: A Multidisciplinary Case Report with 30-Month Follow-Up. Case Reports in Dentistry, 2020(1), 3856412. https://doi.org/10.1155/2020/38564

Downloads

Published

2025-06-27

How to Cite

1.
Pande D, Senthilnathan S, A R T, bhargava S, Murugaraj N, Shah RV. Long-term outcomes of distraction osteogenesis in craniofacial reconstruction. J Neonatal Surg [Internet]. 2025Jun.27 [cited 2025Jul.19];14(32S):2443-51. Available from: https://jneonatalsurg.com/index.php/jns/article/view/7760

Issue

Vol. 14 No. 32S (2025): Journal of Neonatal Surgery

Section

Original Article

License

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

You are free to:

  • Adapt — remix, transform, and build upon the material for any purpose, even commercially.

Terms:

  • Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
  • No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.