Massachusetts General Hospital : Skeletal Biology Research Center
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Distraction osteogenesis
The majority of children with craniomaxillofacial deformities require skeletal expansion. Traditionally, this was accomplished by osteotomies, acute bone lengthening, placement of bone grafts and when indicated soft-tissue flaps. 
When bone grafts are required, there is a second operation to harvest bone (commonly hip, skull, ribs or tibia) or soft tissue. In children, there may be inadequate bone to harvest, leading to multiple donor sites. Bone resorption is unpredictable and may result in an undesired loss of grafted bone volume. Accordingly, seeking novel ways to create new bone without donor-site harvesting is a major goal of the SBRC. One of the most promising new techniques is distraction osteogenesis (DO), the gradual lengthening of bone using a specialized appliance (a “distractor”) to place tension forces across an osteotomy. Candidates for this procedure are children or adults with syndromic micrognathia and airway obstruction requiring tracheostomy (a breathing tube), midface hypoplasia (cleft lip/palate, Crouzon or Apert syndromes), non-syndromic mandibular or maxillary hypoplasia and those with acquired conditions resulting from trauma, tumor resection, or radiation therapy. The benefits of DO can be numerous. In addition to avoiding donor-site morbidity, the procedure can be performed using minimally invasive techniques, sometimes endoscopically. In micrognathic patients, studies show that DO permits the jaw to be moved greater distances than with conventional soperations and that the newly created bone appears to be more stable. Our laboratory has developed a porcine model for DO. We continue to publish results documenting the biology of bone wound healing in the distraction gap using clinical, radiographic, ultrasound, biomechanical and molecular biology techniques. In addition, we have documented changes in the temporomandibular joint in response to DO for mandibular lengthening. We have demonstrated that muscle overlying the distraction wound undergoes proliferation in response to the distraction forces. This is in contrast to the stretching of muscle that occurs with standard osteotomies and bone movement. The journey from bench to bedside is multidisciplinary and multifaceted. In addition to studying the biology of bone-wound healing and muscle response, The SBRC also focuses on minimally invasive access, distractor device design, and 3-D treatment planning. One of the most promising innovations to emerge from this work is a semi-buried, miniature distraction device that is capable of accurate 3-D movements along a curvilinear path. The goal is to develop a totally buried device driven by a micromotor that moves automatically. In partnership with industry, the SBRC has several grants to pursue this development, leading toward a complete approach including a 3-D treatment planning system that incorporates software developed in the Harvard Surgical Planning Laboratory. BibliographyGlowacki J, Schulten AJM, Perrott D, Kaban LB. Nicotine impairs distraction osteogenesis in the rat mandible. Int J Oral Maxillofac 2008;37(2):156-61. Steinbacher DM, Kaban LB, Troulis MJ. Mandibular advancement by distraction osteogenesis for tracheostomy-dependant children with severe micrognathia. J Oral Maxillofac Surg 63(8):1072-1079, 2005. Yeshwant K, Seldin EB, Gateno J, Everett P, White CL, Kikinis R, Kaban LB, Troulis MJ. Analysis of skeletal movements in mandibular distraction osteogenesis. J Oral Maxillofac Surg 63:335-340, 2005. Thurmueller P, Troulis MJ, Rosenberg A, Chuang SK, Kaban LB. Microscopic changes in the condyle and disc in response to distraction osteogenesis of the minipig mandible. Int J Oral Maxillofac Surg (in press) Yeshwant K, Seldin EB, Kikinis R, Kaban LB. A computer-assisted approach to planning multidimensional distraction osteogenesis. Atlas Oral Maxillofac Surg Clin N Am 2005;13:1-12. Zimmermann CE, Harris G, Thurmuller P, Troulis MJ, Perrott DH, Rahn B, Kaban LB. Assessment of bone formation in a porcine mandibular distraction wound by computed tomography. Int J Oral Maxillofac Surg 2004;33:569-574. Glowacki J. Shusterman EM, Troulis MJ, Homes R, Perrott D, Kaban LB. Distraction Osteogenesis of the Porcine Mandible: Histomorphometric Evaluation of Bone Formation. Plast Reconstr Surg 2004;113(2):566-573. Troulis JJ, Coppe C, O’Neill MJ, Kaban LB. Ultrasound: Assessment of the distraction osteogenesis wound in patients undergoing mandibular lengthening. J Oral Maxillofac Surg 2003; 61:1144-1149. Perrott DH, Rahn B, Wahl D, Linke B, Thurmueller P, Troulis MJ, Glowacki J, Kaban LB. Development of a mechanical testing system for a mandibular distraction wound. Int J Oral Maxillofac Surg 2003; 32:523-527. Kaban LB, Thurmueller P, Troulis MJ, Glowacki J, Wahl D, Linke B, Rahn B, Perrott DH. Correlation of biomechanical stiffness with plain radiographic and ultrasound data in an experimental mandibular distraction wound. Int J Oral Maxillofac Surg 2003; 32(2):296-304. Troulis MJ, Kaban LB. Complications of mandibular distraction osteogenesis. Oral and Maxillofac Surg Clin N America 2003;15:251-264. Troulis MJ, Everett P, Seldin EB, Kikinis R, Kaban LB. Three-dimensional treatment planning system based on computed tomographic data. Int J Oral Maxillofac Surg, 2002;31:349-357. |
“In the future, skeletal expansion in the craniomaxillofacial region will be achieved with far less morbidity, greater patient comfort, and more predictable, higher quality outcomes.” Contact Us: Skeletal Biology |