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Abstract Objective To describe the profile of the patients and the results obtained with the use of an external fixator for metatarsal lengthening in brachymetatarsia. Methods A retrospective analysis of the medical records of patients with brachymetatarsia treated between January 2018 and April 2020 was performed. During this period, eight feet of six patients were operated on. Frequencies were estimated according to demographic and surgical aspects. Results All patients (100%; n= 6) were female, with a mean age of 28 years old, ranging from 15 to 48 years old, and were motivated to seek the orthopedic service due to aesthetic deformity. The deformity was bilateral in two patients and unilateral in four patients. The average lengthening time was 22 days ( ± 7.15, 95% confidence interval [CI]: 19.04-26.81). The lengthening speed was 0.5 mm/day, and the average total length of the lengthening was 11.46 mm ( ± 3.57; 95%CI: 9.52-13.40). Half of the patients (50%; n= 3) had local infection of the pins and were treated with antibiotics, and the others did not report any postsurgical complications. All patients denied pain or calluses after the surgical procedure and reported satisfaction with the results. Conclusion All patients were female and sought surgery for brachymetatarsia for aesthetic reasons. Osteogenic distraction at a rate of 0.5 mm/day resulted in successful lengthening of the metatarsal, with a low frequency of complications, good clinical outcomes, and high patient satisfaction.
Resumo Objetivo Descrever o perfil dos pacientes e os resultados obtidos com o uso de fixador externo para alongamento de metatarso em braquimetatarsia. Métodos Foi realizada uma análise retrospectiva dos prontuários de pacientes com braquimetatarsia tratados entre janeiro de 2018 e abril de 2020. Durante este período, foram operados oito pés de seis pacientes. Foram coletadas e estimadas as frequências em relação a aspectos demográficos e cirúrgicos. Resultados Todas as pacientes (100%; n= 6) eram do sexo feminino, com média de idade de 28 anos, variando de 15 a 48 anos, e motivadas a buscar o serviço de ortopedia em função da deformidade estética. O acometimento era bilateral em duas pacientes e unilateral em quatro pacientes. O tempo médio de alongamento foi de 22 dias ( ± 7,15; intervalo de confiança [IC] 95%: 19,04-26,81). A velocidade de alongamento foi de 0,5 mm/dia e o comprimento médio total do alongamento foi de 11,46 mm ( ± 3,57; IC95%: 9,52-13,40). Metade das pacientes (50%; n= 3) teve infecção local dos pinos e foi tratada com antibióticos; as demais não relataram nenhuma complicação pós-cirúrgica. As pacientes negaram dor ou calosidade após o procedimento cirúrgico e relataram satisfação com os resultados. Conclusão Todas as pacientes eram do sexo feminino e buscaram a cirurgia para braquimetatarsia por motivos estéticos. A distração osteogênica a uma taxa de 0,5 mm/dia resultou em alongamento bem-sucedido do metatarso, com uma baixa frequência de complicações, bons resultados clínicos e alta satisfação das pacientes.
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Humans , Female , Adolescent , Adult , Congenital Abnormalities , Foot Deformities , Metatarsal Bones , Patient Satisfaction , Orthopedic Procedures , Osteogenesis, DistractionABSTRACT
Objective@#To evaluate osteotomy, bone shortening and lengthening by one stage with external fixation for a large bone defect following open femoral fracture.@*Methods@#From April 2014 to April 2019, 11 consecutive patients with a large bone defect following open femoral fracture were treated at Department of Orthopaedics, The Sixth People’s Hospital of Shanghai. They were 9 males and 2 females, with an average age of 40.5 years (from 18 to 70 years). The left side was involved in 6 cases and the right side in 5. All their primary open fractures had deteriorated into osteomyelitis and bone defects after treatment. Their bone defects averaged 60.5 mm after thorough debridement. Postoperative X-ray examinations were taken regularly. Bony union time and index, time till removal of external fixator, external fixation index, flap survival, soft tissue healing, visual analogue scale (VAS), Association for Studying and Application of Methods of Ilizarov (ASAMI) scores for bone healing and lower limb function were recorded.@*Results@#All the patients were followed up for 9 to 30 months (mean, 21.9 months). The bony union time averaged 10.5 months (from 5.2 to 22.3 months). The bony union indexes averaged 52.9 d/cm (from 33.4 to 73.3 d/cm). The time till removal of external fixator averaged 15.5 months (from 9.8 to 27.5 months). The external fixation indexes averaged 86.0 d/cm (from 60 to 113 d/cm). All the bone nonunions healed with no recurrence of osteomyelitis. Complications like union failure, refracture at ends of bone lengthening or fracture, or leg length discrepancy>2.5 cm, happened in none. The VAS scores ranged from 0 to 3 points. By ASAMI evaluation, the bony union was excellent in 10 cases and good in one case, and the lower limb function was excellent in 3 cases, good in 7 cases and fair in one.@*Conclusion@#Osteotomy, bone shortening and lengthening by one stage with external fixation is a reliable treatment for large femoral bone defects because this strategy can remove the lesions and restore the femoral length at the same time.
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Objective@#To explore the role of β-catenin in distraction osteogenesis of new bone formation, the expression of β-catenin in the distraction gap callus was detected during rabbit mandibular distraction osteogenesis.@*Methods@#26 New-Zealand rabbits were randomly divided into 3 groups. Group A is a normal control group with 2 rabbits, group B is the mandibular defect control group, and group C is the distraction group. Group B and C with 12 rabbits, respectively. The two rabbits in group A without surgery, their mandibles are normal control. In group B, vertical osteotomy was performed between the first molar and the mental foramen on the mandibles bilaterally, followed by rigid internal fixation with titanium plates and screw with 5 mm gap immediately. In group C, after the same osteotomy was performed, the fragments of mandibles were reduced and fixed with mandibular distractors bilaterally. On the fourth day postoperatively, the distraction started at a rate of 0.8 mm/d and lasted for 7 days, followed by consolidation period. Two rabbits of group B and C were sacrificed at 6th, 10th, 17th, 24th, 31st, 38th day postoperatively, respectively. The newly formed callus in the distraction gap of mandibles was harvested for Western blotting and immunohistochemistry examination to detect the distribution and expression of β-catenin. The experimental data were analyzed by SPSS 22.0 statistical software using Spearman function.@*Results@#The result of Western blotting showed that the expression of β-catenin gradually increased at distraction period(6-10 days after surgery) and reached the peak at the end of the distraction period(10th day postoperatively), it gradually decreased during the consolidation period. However, the expression of β-catenin in group C was higher than that of group B. Immunohistochemistry stain showed that the expression of β-catenin mainly located in inflammatory cells(eg. monocyte), fibroblast of the granulation tissue, the osteoblasts, osteocyte on the surface of new formed trabecular, and the connective tissues surrounding the new bone in the new formed callus. Cytoplasmic and nuclear staining were positive. In group C, the expression of β-catenin was strong (3.245 8±0.132 3) after distraction (6th day postoperatively), and reached a peak (4.602 8±0.021 9) on the 10th day postoperatively. With the disappearance of the distraction stress, the expression of β-catenin gradually decreased since17th day postoperatively(3.639 8±0.125 5), but the staining was still positive. In group B, the strong positive staining of β-catenin on the 6th day after surgery (2.734 0±0.134 7), the strongest staining on the 10th day after surgery (3.101 3±0.104 8), and the expression of β-catenin on the 17th day after surgery (2.542 8±0.211 1) was weaker than that on the 10th day after surgery. At each time point, the expression of β-catenin in group C was significantly higher than that in group B, and the difference was statistically significant (r=0.943, P=0.005 6).@*Conclusions@#During mandibular distraction osteogenesis, the distraction stress activates the Wnt signal pathway to enhance the expression of β-catenin, it suggests that β-catenin plays an important role in the transformation of the mechanical signal to chemical signals during the process of distraction osteogenesis, and participates in the regulation of new bone formation during distraction osteogenesis.
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Objective@#To explore the impact role of Mandibular Distraction Osteogenesis technique (MDO) on the health quality of life in children with Pierre-Robin Sequence (PRS).@*Methods@#From January 2017 to August 2017, 44 cases of children with PRS admitted in children′s hospital of Nanjing Medical University were recruited. Glasgow Children′s benefit inventory(GCBI), Chinese version was used to study postoperative qualify of life in four aspects: physiology, emotions, learning, and vitality. Clinical data and the quality of life score were collected from the patients, and comparison analysis was performed.@*Results@#GCBI total score of the 44 cases of PRS treated with MDO surgery was 46, indicating that the overall quality of life was improved; Physical dimension score was 72, which was the highest, showing the most positive changes. GCBI total scores for the children with different types of PRS were type Ⅰ62, type Ⅱ43, type Ⅲ18, respectively. Nonparametric test showed that quality of life in typeⅠpatients was improved compared to typeⅢ. The difference was statistically significant (Z = -3.34, P=0.01). For the comparisons between type Ⅰ and Ⅱ and type Ⅱ and type Ⅲ, there was no statistically significant difference (P>0.05).@*Conclusions@#MDO plays a positive role in improving life of quality . Physiological conditions were the aspects that were improved most. The milder the case is, the more the postoperative quality of life is improved.
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Objective To evaluate osteotomy,bone shortening and lengthening by one stage with external fixation for a large bone defect following open femoral fracture.Methods From April 2014 to April 2019,11 consecutive patients with a large bone defect following open femoral fracture were treated at Department of Orthopaedics,The Sixth People's Hospital of Shanghai.They were 9 males and 2 females,with an average age of 40.5 years (from 18 to 70 years).The left side was involved in 6 cases and the right side in 5.All their primary open fractures had deteriorated into osteomyelitis and bone defects after treatment.Their bone defects averaged 60.5 mm after thorough debridement.Postoperative X-ray examinations were taken regularly.Bony union time and index,time till removal of external fixator,external fixation index,flap survival,soft tissue healing,visual analogue scale (VAS),Association for Studying and Application of Methods of Ilizarov (ASAMI) scores for bone healing and lower limb function were recorded.Results All the patients were followed up for 9 to 30 months (mean,21.9 months).The bony union time averaged 10.5 months (from 5.2 to 22.3 months).The bony union indexes averaged 52.9 d/cm (from 33.4 to 73.3 d/cm).The time till removal of external fixator averaged 15.5 months (from 9.8 to 27.5 months).The external fixation indexes averaged 86.0 d/cm (from 60 to 113 d/cm).All the bone nonunions healed with no recurrence of osteomyelitis.Complications like union failure,refracture at ends of bone lengthening or fracture,or leg length discrepancy ＞ 2.5 cm,happened in none.The VAS scores ranged from 0 to 3 points.By ASAMI evaluation,the bony union was excellent in 10 cases and good in one case,and the lower limb function was excellent in 3 cases,good in 7 cases and fair in one.Conclusion Osteotomy,bone shortening and lengthening by one stage with external fixation is a reliable treatment for large femoral bone defects because this strategy can remove the lesions and restore the femoral length at the same time.
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Traditional total cranial vault reconstruction for craniosynostosisis traumatic with long operative time and many serious complication. A brand new surgery technique, spring-assisted surgery(SAS), has been invented and performed for 20 years. It showed that SAS has the advantages of less invasive and good result. It has gradually become one of the important methods to treat early craniosynostosis. This article reviewed the SAS related literatures in the past 20 years, focusing on various surgical methods of SAS and possible surgical complications. The osteogenesis principle, prognosis and development of SAS were also summerized.
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Objective@#To investigate the treatment of nasal deformity in patients with unicoronal craniosynostosis.@*Methods@#In patients over 6 months old, the nasal bones were wedge-removed without fixation. The management of all patients with unicoronal craniosynostosis was distraction osteogenesis of pedicled unilateral frontal bone flap.@*Results@#Postoperative extended distance of the frontal bone was 28—41 mm (mean, 35.4 mm). After extension, three-dimensional reconstruction of cranial CT was carried out, which showed that CVAI was 0.8—1.2 (mean, 0.98), tending to normal. After discharge, dynamic cranial braces were put on for 1 year. Postoperatively, the children were followed up for 8—36 months (mean, 28 months). The shape and nasal deformity of all children were improved compared with those before surgery.@*Conclusions@#Nasal wedge resection should be used to correct nasal deformity in children over 6 months with unicoronal craniosynostosis.
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Objective@#To explore the effect of distraction osteogenesis in the treatment of syndromic craniosynostosis.@*Methods@#The clinical data of 6 children with syndromic craniosynostosis from January 2014 to September 2018 were retrospectively analyzed. There were 5 males and 1 female, aged from 1 month and 21 days to 6 years and 1 month, with an average age of 30 months. There were 3 Crouzon syndrome, 1 Pfeiffer syndrome, 1 Vogt syndrome (ACS Ⅱ) and 1 Clove leaf skull syndrome. The distraction osteogenesis apparatus was used in this procedure. The distraction osteogenesis was prolonged twice a day, 0.4 mm each time, and the prolongation was stopped when the skull shape was significantly improved. Three-dimensional CT scans of the skull were reviewed after 6 months, suggesting that distraction osteogenesis was good, then the lengthener was removed. Complications were recorded, and extended distances were measured. Cranial indices before and after operation were compared to evaluate the efficacy, safety and feasibility of the operation.@*Results@#The procedure of operation and traction was successful in all 6 children. There were no complications such as cranial spinal fluid (CSF) leakage or intracranial infection occurred. The increased distance was (19.1±3.3) mm, ranging from 15.2 to 25.6 mm. The preoperative cranial index was 89.6 ±7.3, while the postoperative cranial index was 74.2 ±3.6. All patients were followed up from 3 to 20 months, with the average of 14 months. The posterior cranial flatness was improved, and the patients were satisfied with the surgical results.@*Conclusions@#Distraction osteogenesis is effective and reliable in treating the premature fusion of cranial suture, and it produces excellent result with low rate of CSF leak and infection.
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Objective@#To explore how to select osteotomy line and its significance in mandibular distraction osteogenesis in infants and young children.@*Methods@#From May 2013 to July 2018, 208 infants and young children with mandibular deformity were admitted to the Department of Oral and Maxillofacial Surgery, Guangzhou Women and Children Medical Center, including 131 males and 77 females, with the age range of 8 days to 4 years, mean age of 6 months. Their clinical records were retrospectively analyzed. There were 162 cases of Robin sequence, 37 cases of the first and branchial arch anomalies, 2 cases of Treacher-Collins syndrome, and 7 cases of other congenital malformations. During the distraction osteogenesis, different osteotomy lines were selected according to the characteristics of the mandibular deformity: (1) For short mandibular body, the straight osteotomy line was used to extend the mandibular body. (2) For short mandibular ramus, a polygonal osteotomy line was used to extend the ramus. (3) For the increased mandibular angle, a curved osteotomy line was used to change the angulation.@*Results@#Linear osteotomy was used in 38 patients, polygonal line osteotomy were used in 129 patients, and curved osteotomy was performed in 41 patients. Among them, 4 patients with linear osteotomy had deciduous embryo injury, 6 patients with linear osteotomy and 2 patients with polygonal osteotomy had open occlusion, and patients with curved osteotomy did not have tooth and mandible damage, or malocclusion. All patients were followed up for 3 months to 5 years. The average follow-up time was 6.2 months. All osteotomy healed well, without osteonecrosis or nonunion.@*Conclusions@#For the mandibular distraction osteogenesis, osteotomy line could be individualized, according to the characteristics of mandibular deformity of infants and young children, which can reduce complications such as dental damage and open occlusion.
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Objective@#To investigate the clinical outcome of distraction osteogenesis in the treatment of pediatric maxillofacial fractures.@*Methods@#From November 2017 to November 2018, 6 cases of maxillofacial fractures were treated, including 3 cases of maxillary fracture and 3 cases of mandibular fracture. All of them were associated with facial asymmetry of different severity, disordered occlusion and displacement of fracture segments. The distraction osteogenesis device was used to fix the fracture during the operation. The distraction was initiated after 1 day latency period, and proceeded at approximately 0.5 mm each time, twice a day, until the normal occlusal relationship was achieved. Distractor was maintained for 1 month after distraction, and then removed. The degree of fracture healing, the mouth opening and the occlusal status at the fracture site were evaluated during follow-up, and the corresponding curative effect was observed and evaluated.@*Results@#All fractures were healed well, without infection, dislocation, or pseudo-joint formation after 1 month. The distraction duration is 15-20 days and the distraction distance is 15-20 mm. At the end, the occlusal relationship was normal, and the mouth opening was not limited. The follow-up period was from 1 month to 1 year. The maxillofacial appearance of the children was normal, and the maxillofacial development was not significantly affected.@*Conclusions@#Distraction osteogenesis is an effective and controllable method for child maxillofacial fracture. It can be used as a supplement to the conventional treatment of maxillary and mandibular fracture in children.
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Objective@#To establish finite element models of skull, fronto-orbital advancement and fronto-orbital distraction osteogenesis of craniosynostosis, to analyze the mechanical characteristics of skull base and fronto-orbital operation area, so as to guide the later application of tractors.@*Methods@#One 6-year-old male patient with unilateral coronal synostosis was enrolled in October 2015. Three-dimensional (3D) computed tomography (CT) scan of skull was performed. DICOM data was imported into Mimics 17.0 for contour extraction and cranial 3D reconstruction. The skull model was processed by Mimics, Geomagic Studio 12.0, Hypermesh 12.0 and other software to establish a three-dimensional finite element model. The unilateral and bilateral fronto-orbital anterior osteotomy models were simulated respectively. The mechanical analysis was performed at point A in forehead area and point B in temporal area. Three different groups of traction forces were loaded: (1) 50 Newton for point A, 50 Newton for point B; (2) 80 Newton for point A and 50 Newton for point B; (3) 100 Newton for point A and 50 Newton for point B, to obtain the optimized traction force.@*Results@#Stress analysis was performed on established cranial finite element model, as well as unilateral and bilateral fronto-orbital advancement procedures. The stress distribution of the anterior and middle cranial fossae was found to be concentrated. After unilateral fronto-orbital advancement, the stress of anterior cranial fossa, especially the affected side, was decreased. The stress on both side in anterior cranial fossa was decreased after bilateral fronto-orbital advancement. After force was applied to point A and point B, the optimum deviation result at supraorbital notch point, midpoint of supraorbital margin, frontal temporal point and frontal zygomatic suture point in 3D (Deviation result of X value: -29.4%, -20.5%, -8.6%, -9.3%; Deviation result of Y value: 20.9%, 31.5%, 73.0%, 539.4%; Deviation result of Z value: 4.4%, 1.9%, 0.1%, 11.8%) demonstrated the application of traction force can inwardly, downwardly and forwardly move the bone flap. The optimized traction was 80 Newton at point A and 50 Newton at point B by preliminary assessment.@*Conclusions@#The finite element analysis of the fronto-orbital advancement can be used for more accurate preoperative simulation, to clarify the influence of fronto-orbital advancement on craniofacial morphology and development, as well as skull base. It also facilitates surgical decision and predicts the postoperative distraction vectors.
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Objective@#To evaluate the clinical effect of multiple osteotomies combined with distraction osteogenesis in the treatment of non-syndromic scaphocephaly infants and young children.@*Methods@#Clinical records of 8 non-syndromic scaphocephaly patients, during January 2017 to October 2018, from the Department of Burn and Plastic Surgery, Children′s Hospital of Nanjing Medical University, were retrospectively analyzed. There were 3 males and 5 females, aged from 3 to 28 months, with an average of 13 months. Among them, 4 cases were typical scaphocephaly, 2 cases were anterior scaphocephaly and 2 cases were posterior scaphocephaly. According to the subtypes of scaphocephaly, different osteotomy methods and distraction directions were designed. The cranial vault was osteotomized by piezosurgery osteotomy in a multiple way. The dura did not separate from cranial flap. The internal distractors were installed subsequently. After a mean latency period of 5 days, the devices were activated at a rate of 0.4-0.6 mm/d. Distractor was extended twice a day. After 10-15 days activation period and 6 months consolidation, all the distractors were removed. Three-dimensional CT scans were performed before and after operation to measure the anteroposterior and bitemporal diameters, so as to calculate the cranial index.@*Results@#Follow-up ranged from 6 to 14 months (average, 10 months). The average anteroposterior length of 8 children was(158.2±12.9) mm before operation, and (145.5±14.2) mm after operation, which was shortened(12.6±3.4) mm. Bitemporal diameters was(99.6±8.6) mm preoperatively and(113.9±7.5) mm postoperatively, which was widened (14.2±2.8) mm. Preoperative and postoperative cranial index was 63.2 and 78.3, respectively. The scaphocephalic head shape was significantly improved in all patients. There was no serious complications such as skull necrosis or intracranial infection.@*Conclusions@#Different types of multiple osteotomy combined with distraction osteogenesis are useful to correct various scaphocephaly of infants and children, by improving skull shape and cranial index.
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Introdução: Glossoptose e retrognatia, associadas a distúrbios respiratórios, compõem a Sequência de Robin (SR), que pode estar associada a uma variedade de síndromes genéticas. Sua incidência varia entre 1/5.000 e 1/50.000 nascidos vivos, cursando com níveis variáveis de comprometimento respiratório. A síndrome da apneia e hipopneia obstrutiva do sono (SAHOS) se destaca entre tais distúrbios, conferindo risco de morte neonatal e tempo prolongado de internação. Disfagia é sintoma frequente em pacientes com SR sindrômica, com risco de aspiração. Dentre as alternativas para tratamento do distúrbio respiratório, distração óssea mandibular (DOSM) é uma rápida e definitiva opção, podendo prevenir sequelas, como danos cerebrais por hipóxia, além de corrigir a micrognatia permanentemente. Objetivo: relatar padrão respiratório e da deglutição em paciente com SR após avanço mandibular por distração osteogênica Resultado e discussão: relatamos um caso de paciente com SPR associada à SAHOS grave: índice de distúrbio respiratório (IDR) =18/h, atraso do desenvolvimento neuro-psico-motor, respiração oral e disfagia de grau severo com dieta exclusiva por gastrostomia. Conclusão: após realização de DOSM, houve melhora da SAHOS e a dieta passou a ser ministrada via oral.
Introduction: glossoptosis and retrognatia, associated with respiratory disorders, compose the Robin Sequence (RS), which may be associated with a variety of genetic syndromes. Its incidence ranges from 1/5,000 to 1/50,000 live births with varying levels of respiratory compromise. The Obstructive Sleep Apnea and Hypopnea Syndrome (OSAHS) stands out among such disorders, conferring neonatal death risk and prolonged hospitalization time. Dysphagia is a frequent symptom in patients with syndromic SR, with risk of aspiration. Among the alternatives for the treatment of respiratory disorder, mandibular bone distraction (MBD) is a rapid and definitive option, which can prevent sequelae, such as brain damage through hypoxia, and correct micrognathia permanently. Objective: to report improvement of the respiratory and swallowing pattern in a case of PRS by osteogenic mandible distraction. Result and discussion: we report a case of a patient with SPR associated with severe OSAHS: respiratory distress index (IDR) = 18 / h, neuropsychological-motor development delay, oral breathing, and severe-grade dysphagia with an exclusive gastrostomy diet. Conclusion: after DOSM, there was improvement in OSAHS and the diet was administered orally.
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Humans , Sleep Apnea, Obstructive , RetrognathiaABSTRACT
Craniosynostosis is a group of common congenital craniomaxillofacial deformities. Syndromic craniosynostosis is usually accompanied by increased intracranial pressure, craniocerebral growth restriction, craniofacial deformities and even chiari malformation. Traditional anterior or posterior skull reshaping has its drawbacks such as high surgical risk, high recurrence rate and unsatisfactory therapeutic efficacy, and so on. The operation technique of posterior cranial vault distraction is relatively simple. The treatment process is controllable, accurate and stable. It can largely expand the intracranial volume and improve the anterior and posterior skull configuration with a low risk of complications. To sum up, posterior cranial vault distraction osteogenesis can be a surgical procedure of choice when syndromic craniosynostosis is treated.
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Objective@#To explore the feasibility of mandibular distraction for the treatment of airway obstruction in neonates with Braddock-Carey syndrome.@*Methods@#From August 2007 to November 2017, 6 neonates with Braddock-Carey syndrome were treated in our center. All patients experienced the combined thrombopoietic treatment before operation. Bilateral oblique mandibular osteotomy was performed by extraoral approaches and the distraction was initiated on postoperative day 3 at a rate of 1.2 mm/d. It usually took around 2 weeks to get required length of distraction. Distractor was removed after 3-months fixation at second stage.@*Results@#The distraction distance of 6 cases was from 12 to 20 mm. The CT scan showed a widening gap of the airway by 6-10 mm, and the average width was around 7 mm. 5 patients had no bleeding and infection after the operation, while one patient experienced bleeding for 4 times treated by regional compression. All neonates felt painful during distraction, and got relieved after reduction of the frequency and pace. With mandibular advancement, all patients′ face type improved, while paroxysmal bruising, inspiratory dyspnea and difficulty in breastfeeding disappeared. After 6 months of follow-up, all patients′ weight and face type were basically the same as normal children.@*Conclusions@#With the treatment of thrombocytopenia before operation, complete hematischesis during the operation, and postoperative treatment of thrombocytopenia, mandibular distraction osteogenesis was a feasible and safe management of upper airway obstruction in neonates with Braddock-Carey syndrome.
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Objective@#To investigate the influence of mandibular distraction osteogenesis on masticatory function by analyzing the maximal bite force before and after surgery.@*Methods@#From May 2014 to November 2015, 22 hemifacial microsomia cases, ageing from 6 to 10 years old, underwent mandibular distraction osteogenesis and their biting force data were collected. The maximal bite forces in incisor area, bilateral premolar area and molar area were measured before surgery and 1 year after surgery.@*Results@#The average maximum bite forces in the molar area of the affected side, premolar area of the affected side, incisor area, premolar area of the unaffected side, molar area of the unaffected side were (170.6±42.8)N, (141.9±34.9)N, (89.7±18.8)N, (169.3±29.0)N and (230.2± 56.4)N respectively before surgery. Statistics indicated that most patients had uneven distribution of bite force between the affected side and unaffected side before surgery. And they changed to (198.8±44.0)N, (151.8±31.1)N, (88.9±18.0) N, (167.8±26.1)N and (234.3±52.5)N respectively 1 year after surgery, showing that the bite force in the molar area of the affected side was significantly improved by the surgery(P<0.05). Regression analysis showed that the postoperative bite force distribution had a tendency to become more symmetrical in hemifacial microsomia patients.@*Conclusions@#Mandibular distraction osteogenesis can improve the bite force of the affected side in hemifacial microsomia patients and enhance the balance of masticatory in the long-term postoperatively.
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Objective@#To investigate a new method to treat unilateral coronal synostosis.@*Methods@#2 cm-wide osteotomy was performed over the fused unilateral coronal suture.Oblique osteotomy was performed along the supraorbital rim to do a frontal suture of the glabella (patients less than one year old) or on the opposite side of the supraorbital rim (patients over one year old) after performing a suturectomy of the effected coronal suture. Two internal distraction devices were subsequently placed across the osteotomized, fused coronal suture. At the top of the unfused metopic suture, bring two holes and fixing with 4-0 absorbable suture.Finally, the cranium pieces were divided into 2 pieces and placed in the middle of the frontal bone using biological glue or titanium screws. Five days after the operation, a 0.6 mm distraction was performed twice per day. The distraction was removed 6 months after distraction reaching 30—60 mm.@*Results@#Internal distraction osteogenesis with supraorbital oblique osteotomy was performed in eleven patients suffering from unilateral coronal synostosis from 2014.1 to 2017.1. All the patients had no abnormalities in nerve system, such as cephalomeningitis/ fistaul of cerebrospinal fluid/ epidural hematoma and so on.The distractor was not exposed. The width of extension ranged from 25—39 mm. One patient had infection in the rods around the distraction during the period of fixed, but was cured with antibiotic treatment and got an ideal extension eventually. The rest of 10 patients obtained the expected result . During a mean follow-up period of 12 months (5 to 26 months), all patients were presented with satisfactory cosmetic and functional result . CVAI were close to normal.@*Conclusions@#Treating unilateral coronal synostosis by internal distraction osteogenesis with supraorbital oblique osteotomy reduces the necessity offrontal and supraorbital osteotomy, and the exposure of the base of anterior cranial fossa, renders a safe and effective approach.
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Abstract This study aimed to investigate the effects of different doses of systemic melatonin application on new bone formation during mandibular distraction osteogenesis (DO) in rats. Mandibular DO was performed on 30 adult female Sprague-Dawley rats, which were randomly divided into three groups: control group (CNT), melatonin dose 1 (MLT-D1), and melatonin dose 2 (MLT-D2). A five-day latent waiting period and a ten-day distraction phase followed the surgery. After the surgery, rats from the MLT-D1 and MLT-D2 groups received 25 and 50 mg/kg melatonin, respectively, at 7, 14, 21, 28, and 35 days. The animals were euthanised 28 days after distraction, i.e. at 43 days after surgery. Histological and histomorphometric analyses revealed that the distracted bone area was completely filled with new bone formation in all three groups. The MLT-D2 group exhibited the most new bone formation, followed by MLT-D1 and CNT. The melatonin groups had more osteoclasts than the CNT (p < 0.05). The number of osteoblasts was higher in the melatonin groups than in the CNT group, and the MLT-D2 had more osteoclasts than the MLT-D1 group (p < 0.05). Finally, the osteopontin (OPN) and vascular endothelial growth factor (VEGF) levels were higher in the melatonin groups than in the CNT group, and the MLT-D2 had higher OPN and VEGF levels than the MLT-D1 (p < 0.05). This study suggests that systemic melatonin application could increase new bone formation in DO.
Subject(s)
Animals , Female , Osteogenesis/drug effects , Bone Regeneration/drug effects , Osteogenesis, Distraction/methods , Melatonin/administration & dosage , Antioxidants/administration & dosage , Osteoblasts/physiology , Osteoclasts/physiology , Osteogenesis/physiology , Bone Regeneration/physiology , Immunohistochemistry , Random Allocation , Reproducibility of Results , Treatment Outcome , Rats, Sprague-Dawley , Vascular Endothelial Growth Factor A/analysis , Osteopontin/analysis , Mandible/surgery , Mandible/drug effects , Mandible/physiology , Mandible/pathologyABSTRACT
Objective@#To evaluate the effect of three-dimensional Z-shaped osteotomy with cranium distraction osteogenesis for unilateral lambdoid synostosis.@*Methods@#Imaging the skull as a cuboid, we designed the affected lambdoid suture as the middle line of letter Z, the osteotomy line paralleling to the sagittal suture or extending downward posterior cranial fossa as the two horizontal lines of Z to obtain the three-dimensional Z-shaped osteotomy lines. Two or three distraction devices were installed after removing the cranial bone at the premature fused suture with a width of 2.0-2.5 cm. Since the 5th day after operation, distraction was performed at the rate of 0.6 mm each day, twice a day, until the distraction distance reached 2.0-4.5 cm. Finally, we removed the distractors after fixation for three months.@*Results@#Eleven cases of unilateral lambdoid synostosis were treated successfully. No infection or bleeding happened except for one case with distractor entrance scalp infection. No complications, including the fixed screws displacement, penetrating the cranium and the dura mater or distraction devices retracting, occurred. During a mean follow-up period of 24 months (5 to 36 months), all patients were satisfied with the cosmetic and functional result.@*Conclusions@#Three-dimensional Z-shaped osteotomy with cranium distraction osteogenesis can not only extend upward to raise the cranial height, but also lengthen backward to singularize the occipital carina, forming a well-pleasing occipitalia. Z shape stabilizes the whole plate, making the separated cranial bones not easy to retract. Therefore, using this procedure is effective and mini-invasive, and especially suitable for young infant.
ABSTRACT
Objective@#To explore the effect of managing syndromic craniosynostosis using posterior vault distraction osteogenesis.@*Methods@#The authors conducted a retrospective cohort study of four children with syndromic craniosynostosis treated between 2015 January to 2016 March using posterior vault distraction osteogenesis. The posterior craniotomy was performed from vertex, biparietally to a point above the occipital protuberance. Two distraction devices were fixed in the parasagittal, collinear position. After a latency of 3 days, the device was activated at 0.5 mm/day. After the distraction, the consolidation period was about 6 months.@*Results@#The average distraction distance was 27.3 mm(range, 25 to 30 mm). Cerebrospinal fluid leak happened in one patient. After taken the 3D CT scan, all of them were undertaken the second operation of removing the distraction devices. All the patients were followed up at a mean of 12.8 months (range, 7 to 20 months).@*Conclusions@#It is effective to enlarge the posterior cranial vault using distraction osteogenesis for the syndromic craniosynostosis.