If your child is born with bone deficiencies in the jaw, mid-face, or skull, you may be referred to a craniofacial surgeon. Your craniofacial surgeon may, in turn, recommend a procedure known as distraction osteogenesis in order to lengthen the deficient bone.
After all, we live in an age of miracles.
Thanks to advancing medical technologies, craniofacial surgeons are able to correct many congenital facial deformities with minimally-invasive procedures that yield excellent long-term functional and cosmetic results. Among these, distraction osteogenesis has many practical applications.
We use distraction osteogenesis in post-traumatic surgeries in adults, for instance, but this article will focus on life-saving care for infants and young children who suffer from congenital bone deficiencies as a result of conditions such as:
- Franceshetti Syndrome
- Pierre Robin Sequence
- Treacher-Collins Syndrome
What is distraction osteogenesis?
Distraction osteogenesis—the idea that if you move two segments of bone apart, the body will fill in the gap—has been around for almost a century. But only recently, thanks to rapid advances in medical technologies, have craniofacial surgeons begun applying this technique to the bones of the face.
For over three years now, NOLA Craniofacial’s skilled surgeons have been using distraction osteogenesis with great success in the treatment of congenital defects in the jaw and midface, especially in infants, where for one reason or another, the bone structure did not develop as we would hope.
Distraction osteogenesis is a multiple stage procedure that takes advantage of our body’s natural healing processes. By interfering with bone as it attempts to heal itself, a skilled craniofacial surgeon is able to lengthen that bone over the course of time.
Today, thanks to Virtual Surgical Planning®, surgeons can work with incredible efficiency in achieving much more predicable surgical results. By lengthening the bone only gradually, we allow the other structures of the face—muscle, nerves and skin—to keep pace.
During the initial surgery, the surgeon cuts into the bone at a predetermined location—we will know precisely where we want to make the cut—and we emplace a small device, known as a distraction device. The device may be internal or external depending on the requirements of the specific deformity.
This first surgery is followed by a latency period, during which time the bone will form a healing callous. The length of time depends on the age of the child. In neonates it is almost instantaneous. This phase is basically a waiting period until we begin to activate the distraction device.
Following the latency period and once the callous has formed, the distraction device allows us to stretch that callous gradually over time, lengthening bone and stretching the corresponding soft tissue, including muscle, skin and nerves. The key is a gradual approach—how long depends on the amount of bone needed to complete the repair.
Importantly, this does not hurt the child, and can be done in the home.
Finally, once the bone has been extended to the appropriate length, we allow the body to mature that bone, so that the hardware is no longer necessary.
When is distraction osteogenesis appropriate?
Distraction osteogenesis is a wonderfully responsive technology, but despite what may sound like a straight-forward approach, it is important to remember that every child is different. The treatment is very much patient-driven—no two cases are alike—and it is imperative that we consider and preserve the growth potential of the child going forward.
Generally, distraction osteogenesis is appropriate as an alternative to osteotomies (the surgical cutting and rearrangement of bone) where the amount of movement required exceeds the capacity of soft tissue to expand.
In other words, distraction osteogenesis is most often reserved for severe deformities and especially those which may impair normal function.
Distraction osteogenesis may be applied to all the bones of the face, but it’s most common applications involve the midface and lower jaw.
The most common application is in treating Pierre-Robin Sequence. These children are born with a very small mandible, and their tongues can get stuck in the airway. This used to require a tracheostomy—an incision in the windpipe to enable breathing—but that can now be avoided (along with all of the associated complications).
Here in New Orleans, we have been using distraction osteogenesis to treat Pierre-Robin Sequence for over eight years now—and with excellent results.
Distraction Osteogenesis and Your Child’s Development
Thanks to the advent of Virtual Surgical Planning®, complications related to treatment via distraction osteogenesis are increasingly rare and most often minor, especially relative to the physical, emotional, and social impact of severe craniofacial deformities.
If there is a prenatal diagnosis, it is imperative that the mother is seen and evaluated before birth by an ACPA-certified cleft and craniofacial team.
Indeed, the key to minimizing the impact of surgery on the growth of your child is early consultation and treatment—because the child is growing, you want to minimize the number of surgical interventions, and early intervention is the surest way to do so.