González-Garcia Raúl, Rubio-Bueno Pilar, Naval-Gías Luis, Rodríguez-Campo Francisco J, Escorial-Hernández Verónica, Martos Pedro L, Muñoz-Guerra Mario F, Sastre-Pérez Jesús, Gil-Diez Usandizaga José L, Diaz-González Francisco J
Madrid, Spain From the Department of Oral and Maxillofacial Surgery, University Hospital La Princesa, Madrid.
Plast Reconstr Surg. 2008 Feb;121(2):563-575. doi: 10.1097/01.prs.0000297640.65255.70.
Distraction osteogenesis has been used for reconstruction of bone and soft-tissue defects. The authors present their clinical experience in the reconstruction of mandibular segmental defects by means of internal distraction osteogenesis.
Ten patients with mandibular defects ranging from 30 to 80 mm in length were treated in the authors' department. Internal distraction devices with transcutaneous activators were placed immediately after complete resection of the affected bone. Distraction was initiated 10 days after surgery at a rate of 0.5 mm/day. The consolidation period ranged from 12 to 22 weeks. Finally, the distractor device was removed. In two patients, an additional iliac crest bone graft was needed to complete bone union.
Follow-up ranged from 4 to 47 months after surgery. Partial cutaneous and intraoral exposure was observed in two patients. At the end of the follow-up period, successful distraction osteogenesis was achieved in eight patients. Six patients were alive and free of disease, whereas two patients showed local relapse and required new resective surgery. Complete intraoral exposure with failure of the distraction process was observed in one patient, whereas another patient did not complete distraction because of metastatic disease diagnosed 4 months after surgery.
Good clinical results for reconstruction of mandibular and soft-tissue postablative defects are reported with the use of this technique. The use of semiburied devices provides better aesthetics and acceptable quality of life to the patients. Larger series are required to popularize the use of this procedure.
