This document compares and contrasts distraction osteogenesis (DO) and orthognathic surgery (OGS). Some key differences include:
- DO allows for larger advancements of bone (10+ mm) which are more stable, while OGS is generally not advised for advancements over 7 mm.
- OGS allows for multidirectional movements of bone segments while DO is limited and cannot perform impactions, setbacks, or compressions.
- Planning and surgical procedures are generally less complex for DO compared to OGS which may involve multiple segmented osteotomies.
- DO eliminates the need for bone grafting and surgical splints during surgery. Recovery is also typically less invasive than OGS.
Indications of orthognathic surgery and surgical proceduresMaherFouda1
this explains indications of performing orthognathic surgery.It also explains different surgical procedures for different severe forms of malocclusion .
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Indications of orthognathic surgery and surgical proceduresMaherFouda1
this explains indications of performing orthognathic surgery.It also explains different surgical procedures for different severe forms of malocclusion .
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Used in the right conditions, SFOA is highly successful and has a positive impact on the patients psychosocial status.A combined orthodontic and orthognathic surgery approach is accepted as the standard of care for patients who have a severe skeletal jaw discrepancy with facial asymmetry.
But some disadvantages have been recognized.
One drawback is the long presurgical treatment time that typically worsens facial appearance and exacerbates the malocclusion. In some countries, these disadvantages have caused patients to seek plastic surgeons who are willing to perform orthognathic surgeries without collaboration with orthodontists or consideration for the final occlusion.
Recently, to address patient demand and satisfaction, the surgery-first approach was introduced to overcome some disadvantages associated with the conventional surgical orthodontic approach.1991-Brachvogel et al. suggested the potential advantages of a surgery-first approach.
In that article the advantages of post-surgical orthodontics are outlined as follows:
1) Orthodontic movement does not interfere with compensatory biological responses.
2) Dental movements can be based on an already corrected skeletal pattern.
3) Some surgical relapse can be managed during treatment.
2009: Nagasaka et al., popularized SFOA54. Nagasaka et al1 were among the first to actually carry out SFOA using miniplates for post-surgical orthodontic treatment
The 2011 symposium presented the surgery‑first approach and created broader interest in the complete elimination of time‑consuming preoperative orthodontic treatment
Changes on Maxillary Sinus and Pharyngeal Airway Space after orthognathic sur...Turgut Novruzlu
Presentation about impact of Bimaxillary orthognathic surgery on Maxillary Sinuses and PAS. Evaluation with CBCT. Article investigation. 2018 Research, rejected null hypothesis that orthognathic surgeries does not affect dimensions maxillary sinuses and PAS. BSSO. Bilateral Split Sagittal Osteotomy, LeFort1
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Distraction osteogenesis in orthodontics -Dr.G V SHETTYDr.G.V SHETTY
DISTRACTION IN ORTHODONTICS IMPLICATIONS
ROLE OF ORTHODONTIST IN MANAGEMENT OF SEVERE MAXILLOMANDIBULAR OR OROFACIAL DISCREPANCY
SCOPE OF DISTRACTION OSTEOGENESIS
Distraction osteogenesis versus bsso for advancement of the retrognathic mand...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Evolution of orthognathic surgery /certified fixed orthodontic courses by Ind...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Distraction osteogenesis (DO) is a surgical technique that takes advantage of
natural wound healing mechanisms to augment bone and soft tissues. DO is
extremely versatile and can be applied to nearly any bone. In the craniofacial
skeleton, the cranial vault, midface, maxilla andmandible are themost common
sites for DO. This technique allows larger skeletal movements than could be
achieved with conventional techniques, decreases operative time and blood
loss, eliminates the need for bone grafts and associated donor site morbidity,
and may improve postoperative stability. DO can be used in preparation for, in
lieu of, or in combination with orthognathic surgery to correct dentofacial deformities.
Used in the right conditions, SFOA is highly successful and has a positive impact on the patients psychosocial status.A combined orthodontic and orthognathic surgery approach is accepted as the standard of care for patients who have a severe skeletal jaw discrepancy with facial asymmetry.
But some disadvantages have been recognized.
One drawback is the long presurgical treatment time that typically worsens facial appearance and exacerbates the malocclusion. In some countries, these disadvantages have caused patients to seek plastic surgeons who are willing to perform orthognathic surgeries without collaboration with orthodontists or consideration for the final occlusion.
Recently, to address patient demand and satisfaction, the surgery-first approach was introduced to overcome some disadvantages associated with the conventional surgical orthodontic approach.1991-Brachvogel et al. suggested the potential advantages of a surgery-first approach.
In that article the advantages of post-surgical orthodontics are outlined as follows:
1) Orthodontic movement does not interfere with compensatory biological responses.
2) Dental movements can be based on an already corrected skeletal pattern.
3) Some surgical relapse can be managed during treatment.
2009: Nagasaka et al., popularized SFOA54. Nagasaka et al1 were among the first to actually carry out SFOA using miniplates for post-surgical orthodontic treatment
The 2011 symposium presented the surgery‑first approach and created broader interest in the complete elimination of time‑consuming preoperative orthodontic treatment
Changes on Maxillary Sinus and Pharyngeal Airway Space after orthognathic sur...Turgut Novruzlu
Presentation about impact of Bimaxillary orthognathic surgery on Maxillary Sinuses and PAS. Evaluation with CBCT. Article investigation. 2018 Research, rejected null hypothesis that orthognathic surgeries does not affect dimensions maxillary sinuses and PAS. BSSO. Bilateral Split Sagittal Osteotomy, LeFort1
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Distraction osteogenesis in orthodontics -Dr.G V SHETTYDr.G.V SHETTY
DISTRACTION IN ORTHODONTICS IMPLICATIONS
ROLE OF ORTHODONTIST IN MANAGEMENT OF SEVERE MAXILLOMANDIBULAR OR OROFACIAL DISCREPANCY
SCOPE OF DISTRACTION OSTEOGENESIS
Distraction osteogenesis versus bsso for advancement of the retrognathic mand...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Evolution of orthognathic surgery /certified fixed orthodontic courses by Ind...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Distraction osteogenesis (DO) is a surgical technique that takes advantage of
natural wound healing mechanisms to augment bone and soft tissues. DO is
extremely versatile and can be applied to nearly any bone. In the craniofacial
skeleton, the cranial vault, midface, maxilla andmandible are themost common
sites for DO. This technique allows larger skeletal movements than could be
achieved with conventional techniques, decreases operative time and blood
loss, eliminates the need for bone grafts and associated donor site morbidity,
and may improve postoperative stability. DO can be used in preparation for, in
lieu of, or in combination with orthognathic surgery to correct dentofacial deformities.
Distraction osteogenesis, also called callus distraction, callotasis and osteodistraction, is a process used in orthopedic surgery, podiatric surgery, and oral and maxillofacial surgery to repair skeletal deformities and in reconstructive surgery
“Perio-Implant Synergy”- Two lectures on “Lost Buccal Plate- Complications and Management” and “Failing to Plan is Planning to Fail”. Organized by the Society of Periodontists and Implantologists of Kerala” at PMS Dental College, Trivandrum, India on 17/9/2018.
COS definition, development and treatment in orthodontics. Deep overbite and reverse curve. Different ways to level the COS. intrusion, extrusion or both.
Megaprosthetic replacement of knee in a young boy of 14 yearsApollo Hospitals
Now a days, Total Knee Replacement (TKR) is a common for elderly patients but is an uncommon procedure in young individuals. Recently, limb conservation surgery for malignant bone tumours like osteosarcoma around the knee has become a common indication for TKR in young. We report, here a histologically confirmed osteosarcoma in right
proximal tibia of a 14-year-old boy who was managed successfully by limb salvage surgery using Global Modular Replacement System (GMRS, Stryker).
A magnetic resonance imaging studyof the temporomandibular joint and the disc...Abu-Hussein Muhamad
Causative correction of skeletal malocclusions is achieved through bite–jumping by various means. Numerous animal experiments yielded evidence of rebuilt temporomandibular structures after mandibular protrusion. However, the mode and extent of structural and/or topographic changes of the disco-condylar relation after functional orthopaedic treatment is still an issue at stake. A problem exists in defining the physiologic (centric) position of the condyles and the proper disco-condylar relation which is tentatively determined by various methods particularly in MRI studies. Despite the high resolution provided, the results have to be interpreted with caution, as osseous resorption and apposition can not be assessed by visual evidence. In this article a prospective study is presented which proves the effectiveness of the “Wuerzburg concept“, i.e. bionator plus extraoral traction and up-and-down elastics, and its impact on the temporomandibular joint. The underlying reactions are studied by means of MR images obtained from sucessfully treated patients.
A magnetic resonance imaging studyof the temporomandibular joint and the disc...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
“Horizontal Ridge Augmentation- Worth or Vain?”- Guest lecture as a part of “Perio Interactions- Edition IX” conducted by Saveetha Dental College and Hospitals, Chennai on 20/12/2017.
Welcome to Secret Tantric, London’s finest VIP Massage agency. Since we first opened our doors, we have provided the ultimate erotic massage experience to innumerable clients, each one searching for the very best sensual massage in London. We come by this reputation honestly with a dynamic team of the city’s most beautiful masseuses.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
We understand the unique challenges pickleball players face and are committed to helping you stay healthy and active. In this presentation, we’ll explore the three most common pickleball injuries and provide strategies for prevention and treatment.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
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Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
3. Introduction
Precious et al. remarks that, ‘‘Orthognathic
surgery consists of a constellation of
procedures that permit differential
alteration and repositioning of bone,
cartilage, muscle, teeth, gingiva, mucosa,
and skin’’, while distraction osteogenesis is
described as a biologic process of new
bone formation between the surfaces of
bone segments that are gradually
separated by incremental traction.
4. Pre-operative planning
Age-
DO is versatile and can be performed at any
age, from neonates to adults as long as the
patient is physiologically capable to undergo
surgery.
OGS are not performed in neonates and young
children and are generally recommended only
after the skeletal growth completion occurs
Weinzweig J (2010) Plastic surgery secrets plus e-book. Chapter 31: principles of distraction
osteogenesis.
5. An example of isolated Pierre Robin sequence. Note that along with micrognathia
apparent on facial profile, there is glossoptosis, with the tongue prolapsed into the
incomplete cleft in the palate.
6.
7. Pre-operative Imaging and Planning
DO warrants (CT) scanning for pre-op planning.
Radiographs like OPG, lat. ceph. and PA cephalograms suffice in the treatment
planning for orthognathic surgeries, unless the procedure is planned with
(CAD/CAM) to fabricate customized splints, cutting guides and (PSI).
DO doesn’t mandate complex virtual pre-operative planning to simulate (3D)
movements, whereas in case of osteotomies that involve 3D movements of
maxillomandibular complex, virtual planning software that incorporate DICOM
data are commonly employed, in recent times.
Kim SJ, Lee KJ, Yu HS, Jung YS, Baik HS (2015)
Threedimensional effect of pitch, roll, and yaw rotations on
maxillomandibular complex movement. J Cranio-Maxillofac
Surg 43(2):264–273
8. Movements
Quantum of Bone Movement
In OGS advancements of more than 7 mm are not
advisable and those of more than 10 mm are considered
to be with an elevated risk of relapse.
Distraction osteogenesis is a popular modality for larger
advancements of 10 mm or more, as it remains relatively
stable.
Bailey LT, Cevidanes LH, Proffit WR (2004) Stability and
predictability of orthognathic surgery. Am J Orthod
Dentofac Orthop 126(3):273–277
9.
10.
11. Prediction of Bone Movement
Vector control is crucial in the planning for DO, where the placement
of the distractor dictates the primary vector.
OGS offers, in most instances, predictable movements through
precise pre-operative planning and intra-operative usage of splints
to optimize the bone position.
Shirota T, Shiogama S, Asama Y, Tanaka M, Kurihara Y,
Ogura H, Kamatani T (2019) CAD/CAM splint and
surgical navigation allows accurate maxillary segment
positioning in Le Fort I osteotomy. Heliyon 5(7):e02123
12. Directions of Bone Movement
A major drawback of distraction is that impaction,
setback or compression of bone is not possible.
OGS provides the possibility of bone movements in
multiple directions in space, including retraction, and
correction of discrepancies like vertical maxillary excess.
Van Sickels JE (2000) Distraction osteogenesis versus
orthognathic surgery. Am J Orthod Dentofac Orthop
118(5):482–484
13. Three-Dimensional Bimaxillary
Movements
OGS can offer complete movement of the entire maxillo-
mandibular complex, which acts as a rigid body with six
degrees of freedom in 3D space.
It is difficult to manipulate 3D movements of the maxillo-
mandibular complex, in a single stage through DO.
Kim SJ, Lee KJ, Yu HS, Jung YS, Baik HS (2015)
Threedimensional effect of pitch, roll, and yaw rotations
on maxillomandibular complex movement. J Cranio-
Maxillofac Surg 43(2):264–273
14. Surgical Procedures
DO as Interim Procedure
DO can be used as a part of a staged surgical treatment plan to achieve early
correction from childhood, to minimize the deformities in patients with severe
skeletal discrepancies. It does not induce permanent growth in the regions of
genetically determined growth centre deficits . Hence, it can be used to
minimize the quantum of deformity, providing a socially acceptable appearance.
OGS has limitations and cannot be used as an interim procedure and is
preferred after growth completion. Osteotomies in the growing patients will
necessitate future interventions, as growth spurts would produce changes in the
final maxillo-mandibular relationship.
Liu Y, Khadka A, Li J, Hu J, Zhu S, Hsu Y, Wang Q, Wang D (2011) Sliding
reconstruction of the condyle using posterior border of mandibular ramus in
patients with temporomandibular joint ankylosis. Int J Oral Maxillofac Surg
40(11):1238–1245
15. Composite Distraction Versus
Multiple Osteotomies
Multiple independent distraction of the bone segments in
the naso-maxillary zygomatic complex aren’t commonly
performed.
OGS offers the possibility of movements of the bone
segments in the naso-maxillary zygomatic complex through
simultaneous LeFort I and LeFort III osteotomies, followed by
fixation separately.
Brown MS, Okada H, Valiathan M, Lakin GE (2015) 45
years of simultaneous Le Fort III and Le Fort I
osteotomies: a systematic literature review. Cleft Palate-
Craniofac J 52(4):471–479
16. Calvarial Deformity Correction
While correcting calvarial deformities in paediatric patients with
osteotomies, there is an absolute necessity of intervening bone/cartilage
grafts and resorbable plates to be used, as indicated in brachycephaly and
craniosynostosis.
Procedures like LeFort III distractions or frontoparietal (monobloc)
distractions , negate the use of interpositional grafts. Posterior cranial
vault distraction offers considerable advantage over posterior vault
osteotomies in craniosynostosis patients and the usage of internal,
resorbable distractors nullify the need for an additional surgery.
Maurice SM, Gachiani JM (2014) Posterior cranial vault
distraction with resorbable distraction devices. J
Craniofac Surg 25(4):1249–1251
17. Multiple Segmentations
OGS offers the possibility to address the segmental
discrepancies of maxilla or midface, by separating them into
predetermined segments during surgery , and requires
intricate planning and intra-operative splints.
Three or four pieces of segmentalization is not an option
while performing DO, because they will make the distraction
segments unstable.
Rachmiel A, Aizenbud D, Peled M (2005) Long-term
results in maxillary deficiency using intraoral devices. Int J
Oral Maxillofac Surg 34(5):473–479
18. Obstructive Sleep Apnoea
Paediatric- In severe forms of syndromic mandibular deficiencies and maxillary hypoplasia,
distraction osteogenesis is the initial modality of treating (OSA).
In TMJ ankylosis, pre-release distraction has been advocated to correct OSA for immediate
airway improvement and better vector control of distal mandibular segment against stable
proximal ankylosed ramus component.
OGS don’t have a role in paediatric OSA management.
Adults-Though maxillomandibular orthognathic rotation advancements are mostly preferred
for OSA correction, distraction of isolated mandible/maxillomandibular complex is performed
prior to ankylotic release similar to the paediatric group.
Heggie AA, Kumar R, Shand JM (2013) The role of distraction
osteogenesis in the management of craniofacial syndromes.
Ann Maxillofac Surg 3(1):4
19. Transverse Skeletal and Dental
Discrepancies
DO is the best option for transverse skeletal
discrepancies, as it obviates the need for extractions &
proximal stripping, to gain space in the upper and lower
arches & to achieve facial fullness.
OGS require transverse discrepancy management and
space gain before surgery; hence, extractions and
proximal stripping play a vital role in planning.
Van Sickels JE (2000) Distraction osteogenesis
versus orthognathic surgery. Am J Orthod Dentofac
Orthop 118(5):482–484
20. Segmental Defects
Transport DO offers the possibility of reconstructing continuity
defects of the maxillofacial region. It can be achieved through
incremental movement of one (bifocal distraction), two (trifocal
distraction) or three (quadrifocal distraction) viable bone segments
across a defect.
OGS cannot replicate this movement and are not indicated for
bridging segmental defects.
Zapata U, Elsalanty ME, Dechow PC, Opperman LA
(2010) Biomechanical configurations of mandibular
transport distraction osteogenesis devices. Tissue Eng
Part B Rev 16(3):273–283
21. Irradiated Cases
DO has been successfully performed in conditions with
compromised vascularity like irradiated mandibles.
Confirmation of bone viability and the condition of
surrounding soft tissues are vital parameters in ensuring
the success of distraction in irradiated cases.
Barrera A, Salinas F, San Martin F (2011) Orthognathic
surgery in irradiated patient: a case report and literature
review. Int J Oral Maxillofac Surg 10(40):1202
22. Compromised Bone Quality
Bone regeneration has been observed after DO, in suboptimal
clinical situations like scarred tissues wherein the native periosteum
had been destroyed.
OGS can be performed only in situations, wherein there are no
disruptions of periosteum & with healthy soft tissue cover.
Osteotomy cuts raise the risk of unfavourable fractures and bad
splits in patients with low bone mineral density disorders like
osteoporosis.
Barrera A, Salinas F, San Martin F (2011) Orthognathic
surgery in irradiated patient: a case report and
literature review. Int J Oral Maxillofac Surg 10(40):1202
23. Condylar
Hyperplasia/Hypertrophy
DO has no role in managing situations like condylar
hypertrophy/hyperplasia, as it doesn’t influence the growth
centre, which is actually the etiological factor.
Surgical interventions for condylar hyperplasia either in
isolation or with maxillomandibular osteotomies are the
treatment of choice in such pathologies at appropriate age.
Almeida LE, Zacharias J, Pierce S (2015) Condylar
hyperplasia: an updated review of the literature. Korean J
Orthod 45(6):333–340
24. Neo-condyle Rehabilitation
In TMJ ankylosis, after resection of the ankylotic segment, reconstruction can be done with
neocondyle distraction using ramus segment.
The biomechanical properties of neo-condyle, under functional loading are equal to that of
physiologic condyle. Histological analysis has revealed the distraction gap filled with collagen
fibrous tissue gets gradually replaced by mature bone after 24 weeks postdistraction. A
pseudo-meniscus is formed by the fibrocartilaginous cap at the advancing front of distraction,
replicating a normal anatomic form.
OGS can also be employed to achieve this by vertical sliding ramus osteotomies, where the
stump of the posterior ramus can replace the condyle; however, there is no formation of a
fibrocartilaginous cap which will act as a pseudo-meniscus.
Sharma R, Manikandhan R, Sneha P, Parameswaran A, Kumar
JN, Sailer HF (2017) Neocondyle distraction osteogenesis in
the management of temporomandibular joint ankylosis:
report of five cases with review of literature. Indian J Dent
Res 28(3):269
25. Intra-operative Factors-
Osteotomy Design
DO involves linear bicortical osteotomy separation but it can
also be performed in certain instances with cortical scoring,
like in neonatal distraction of Pierre Robin sequence or
Treacher Collins syndrome, to serve the purpose of
emergency airway improvement.
In OGS, specifically designed osteotomy cuts are done, for
complete mobilization and movement of the osteotomized
segments in different planes.
Faria R, Valladares S (2016) Distraction osteogenesis in
Pierre Robin sequence. Austin J Otolaryngol 3(2):1074
26. Bone Grafting
As DO eliminates the need for autogenous bone harvesting and grafting at the site of bone
movement, there is no donor site morbidity. The only indication for bone grafting after
distraction will be in cases of transverse deficiencies, specifically in areas of mandibular ramus
or zygoma, to achieve optimal symmetry, if warranted.
In orthognathic maxillary advancements of more than 7 mm, bone grafts are desirable to
stabilize the osteotomized segments. This autogenous bone grafting has disadvantages like
donor site morbidity, infection of the bone graft, resorption and subsequent relapse due to
resorption. Immediate bone grafting or the usage of synthetic substitutes for augmentation is
an advantage of OGS over DO, as fixation of those can be done simultaneously.
Precious DS (2007) Treatment of retruded maxilla in cleft lip
and palate—orthognathic surgery versus distraction
osteogenesis: the case for orthognathic surgery. J Oral
Maxillofac Surg 65(4):758–761
27. Need for Overcorrection
For growing patients with facial asymmetry, who undergo
distraction, mild overcorrection of the segments is advised,
to catch up with the growth of unaffected side and also to
reduce the later discrepancies that might occur during
growth.
Overcorrection is not practised for orthognathic surgery
patients, as they are operated after growth cessation with
final planned occlusion in mind.
Molina F (2009) Mandibular distraction osteogenesis: a
clinical experience of the last 17 years. J Craniofac Surg
20(8):1794–1800
28. Necessity for Surgical Splints
When osteotomy cuts are placed in orthognathic surgery, it
is imperative to use splints, which serve as an intra-operative
guide to establish a pre-surgically planned occlusion.
Surgical splints are not essential in distraction cases, as it
only involves the mobilization of segments, followed by
fixation of the devices.
Bachelet JT, Cliet JY, Chauvel-Picard J, Bouletreau P (2016)
Observations on the role of surgical splints In
orthognathic surgery. J Dentofac Anom Orthod 19(2):207
29. Role for Transfusion
Distraction procedures are less invasive with a lower
necessity for post-operative blood transfusion, due to
minimal manipulation of hard and soft tissues.
Bimaxillary orthognathic procedures have an increased
propensity for post-operative blood transfusions.
Sammanbds N, Cheung LK, Tong AC, Tideman H
(1996) Blood loss and transfusion requirements in
orthognathic surgery. J Oral Maxillofac Surg
54(1):21–24
30. Duration of Surgery
Incision to closure time for a distraction procedure for
maxilla or mandible is lower than a similar procedure
performed as an OGS.
Van Strijen PJ, Breuning KH, Becking AG, Perdijk FB,
Tuinzing DB (2003) Cost, operation and hospitalization
times in distraction osteogenesis versus sagittal split
osteotomy. J Cranio-Maxillofac Surg 31(1):42–4
31. Post-operative Issues
Biomechanics of Bone Healing
Histologically, the healing process in sites of distraction osteogenesis differs from osteotomy
in two basic aspects. There is an advantage of having a controlled microtrauma and an
intramembranous ossification. The controlled microtrauma present during the activation
phase of distraction stimulates osteoblast proliferation, bone extracellular matrix (ECM)
synthesis and induces growth factors.
In orthognathic osteotomy sites, the healing is produced by endochondral processes, similar
to fracture healing.
Hegab AF, Shuman MA (2012) Distraction osteogenesis of
the maxillofacial skeleton: biomechanics and clinical
implications. Sci Rep 1(11):509
Olate S, Va´squez B, Sandoval C, Vasconcellos A, Alister JP,
Del Sol M (2019) Histological analysis of bone repair in
mandibular body osteotomy using internal fixation system in
three different gaps without bone graft in an animal model.
Biomed Res Int 2019:8043510
32. Post-surgical Imaging
DO mandates, regular monitoring of the progress of the distraction
regenerate consolidation, direction and dimension of movement,
through serial radiographs.
Orthognathic procedures require post-operative radiographs to
assess the degree of movement and fixation and will require further
investigation when a complication arise.
Andrade N, Aggrawal N, Jadhav G, Sahu V, Mathai PC
(2018) To determine the efficacy of ultrasonography in
the evaluation of bone fill at the regenerate site for
mandibular distraction osteogenesis over clinical and
radiographic assessment: an in vivo prospective study.
J Oral Biol Craniofac Res 8(2):89–93
33. Assessment of Post-operative
Changes
Occlusion
DO has a tendency to cause mild to severe occlusal discrepancies as
the movements are planned at basal bone level.
OGS relies on planning and predictability. The patient undergoes
presurgical orthodontics and the intra operative final position is
determined by the splint. After the surgical procedure, the patient is
referred to the orthodontist to correct the expected post-operative
changes in occlusion.
Ow A, Cheung LK (2009) Skeletal stability and
complications of bilateral sagittal split osteotomies
and mandibular distraction osteogenesis: an evidence-
based review. J Oral Maxillofac Sur 67(11):2344–2353
34. Condylar Position
The BSSOis notorious for producing inadequate condylar positioning
and displacement, which had led to condylar resorption and
subsequent internal derangement
DO, which is performed for either anteroposterior or transverse
discrepancies of the mandible, has lesser incidences of TMJ
complications when compared with procedures like BSSO or with
vertical symphyseal step osteotomies.
Ow A, Cheung LK (2009) Skeletal stability and
complications of bilateral sagittal split osteotomies
and mandibular distraction osteogenesis: an evidence-
based review. J Oral Maxillofac Sur 67(11):2344–2353
35. Velopharyngeal Changes
In patients undergoing maxillary advancement for moderate cleft
maxillary hypoplasia of less than 10 mm, DO has no significant advantage
over OGS in preventing velopharyngeal incompetence (VPI) or speech
disturbances.
In patients with severe cleft maxillary hypoplasia of more than 10 mm,
performing a Le Fort I osteotomy increases VPI in patients with pre-
existing borderline VPI , but maxillary advancements achieved through
DO have markedly minimal effects on velopharyngeal competence.
Chua HD, Whitehill TL, Samman N, Cheung LK (2010)
Maxillary distraction versus orthognathic surgery in
cleft lip and palate patients: effects on speech and
velopharyngeal function. Int J Oral Maxillofac Surg
39(7):633–640
36. Concomitant Histogenesis
One of the major advantages of distraction osteogenesis is the concurring
distraction histogenesis. This phenomenon explains the simultaneous
expansion of the soft tissues, including skeletal muscles, nerves,
ligaments, fat, skin and gingiva, in concert with the lengthened bone,
thereby producing excellent aesthetic and functional results
In OGS, as the facial bones are advanced in an acute fashion and fixed in
its new planned position, the adjacent soft tissues are stretched and they
tend to displace the bony segments back to their previous positions to a
certain degree.
Rachmiel A (2007) Treatment of maxillary cleft palate:
distraction osteogenesis versus orthognathic
surgery—part one: maxillary distraction. J Oral
Maxillofac Surg 65(4):753–757
37. Additional Interventions
In patients with internal submerged distraction devices, an
additional surgery is necessary, to remove the device and to
excise the hypertrophic scarred tissue at the site of activation
arm.
As OGS is usually a definitive single stage procedure, the
necessity for additional surgeries is rare.
Scott AR (2016) Surgical management of Pierre Robin
sequence: using mandibular distraction osteogenesis to
address hypoventilation and failure to thrive in infancy.
Facial Plast Surg 32(02):177–187
38. Patient Compliance
OGS, unlike distraction, is almost entirely an intraoral
procedure which is generally well tolerated with superior
patient compliance. The overall satisfaction rate of
patients, after orthognathic surgeries, is very high
Soh CL, Narayanan V (2013) Quality of life assessment in
patients with dentofacial deformity undergoing orthognathic
surgery—a systematic review. Int J Oral Maxillofac Surg
42(8):974–980
39. Follow-Up Visits
Constant post-operative follow-up visits are mandatory
following distraction procedures, to check for regularity
in activation, and also to note the occurrence of
complications, if any.
Numerous visits are not necessary after an orthognathic
surgical procedure.
Van Strijen PJ, Breuning KH, Becking AG, Perdijk FB,
Tuinzing DB (2003) Cost, operation and hospitalization
times in distraction osteogenesis versus sagittal split
osteotomy. J Cranio-Maxillofac Surg 31(1):42–45
40. Duration of Treatment
DO entails a prolonged treatment time, lasting at least 3
months.
OGS are single step procedures, and only the adjuvant
orthodontic treatment might cause an increase in the
treatment duration.
Onger ME, Bereket C, Sener I, Ozkan N, Senel E, Polat AV
(2017) Is it possible to change of the duration of
consolidation period in the distraction osteogenesis with the
repetition of extracorporeal shock waves? Med Oral Patol
Oral 22(2):e251
41. Complications
Relapse
DO has lower relapse rates with larger advancements, as there is decreased
force needed to lengthen the bone due to the phenomenon of distraction
histogenesis.
In OGS, advancements of more than 10 mm in any direction are considered
to be with an elevated risk of relapse.
Van Strijen PJ, Breuning KH, Becking AG, Tuinzing DB (2004) Stability
after distraction osteogenesis to lengthen the mandible: results in
50 patients. J Oral Maxillofac Surg 62(3):304–307
42. Post-operative Infection
The distraction rods that penetrate the oral mucosa are
portals of entry for infection.
The infection rates in orthognathic surgery patients are
very minimal or even nil, if proper antibiotic regimen is
followed.
Cheung LK, Chua HD, Ha¨gg MB (2006) Cleft maxillary
distraction versus orthognathic surgery: clinical
morbidities and surgical relapse. Plast Reconstr Surg
118(4):996–1008
43. Extra Oral Scarring
External distraction devices anchored by transcutaneous pins
are used to transport and stabilize the skeletal fragments.
Though there are numerous advantages like less infection
rate, easy adjustment of vector and easy removal, these pins
are prone to cause scarring of the skin.
OGS has no extra oral scarring as the approaches are always
made transorally, barring a few procedures like extraoral
ramus osteotomies and Lefort III osteotomies
Chin M, Toth BA (1996) Distraction osteogenesis in
maxillofacial surgery using internal devices: review of five
cases. J Oral Maxillofac Surg 54(1):45–53
44. Neurological Deficits
The larger incidences of persistent long-term inferior alveolar nerve
(IAN) disturbances have been reported following (BSSO).
Mandibular distraction has lower incidences of persistent sensory
nerve disturbances when compared to OGS, between 6 and 10 mm
of distraction.
Makarov MR, Harper RP, Cope JB, Samchukov ML (1998)
Evaluation of inferior alveolar nerve function during
distraction osteogenesis in the dog. J Oral Maxillofac Surg
56(12):1417–1423
Van Strijen PJ, Breuning KH, Becking AG, Perdijk FB, Tuinzing
DB (2003) Cost, operation and hospitalization times in
distraction osteogenesis versus sagittal split osteotomy. J
Cranio-Maxillofac Surg 31(1):42–45
45. Complications in Specific Craniofacial
Procedures
Frequent and severe complications like cerebrospinal fluid
leakage, meningitis, subgaleal haematoma, transection of the
infraorbital nerve, strabismus and ptosis have a higher
incidence in patients undergoing LeFort III osteotomy than
those undergoing LeFort III distraction.
Bradley JP, Gabbay JS, Taub PJ, Heller JB, O’Hara CM,
Benhaim P, Kawamoto HK Jr (2006) Monobloc advancement
by distraction osteogenesis decreases morbidity and relapse.
Plast Reconstr Surg 118(7):1585–1597