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Introduction
Overview

1. Introduction

2. Historical Perspective

3. Maxillofacial Application

4. The Process

5. The Device

Chapter One
Principles of Alveolar Distraction Osteogenesis
    

     1.  Section I

     2.  Section II

     3.  Section III

     4.  Section IV

     5.  Section V

     6.  Section VI

     7.  Section VII

     8.  Section VIII

     9.  Section IX

   10.  Section X

   11.  Section XI

Chapter Two
Alveolar Distraction Osteogenesis

1. Section I

2. Section II

3. Section III

4. Section IV

5. Section V

6. Section VI

7. Section VII

8. Section VIII

9. Section IX

Chapter Three
Maxillary Alveolar Distraction
Osteogenesis

1. Section I

2. Section II

3. Section III

4. Section IV

5. Section V

6. Section VI

7. Section VII
   

Why not apply the Ilizarov method directly to maxillofacial skeletal reconstruction? There are a number of unique features of the facial skeleton that require special consideration when applying distraction osteogenesis. When confronting a length deficiency of the leg, for example, the anatomical structures are generally related in a linear, coaxial arrangement. Lengthening using an Ilizarov ring fixator is appropriate because the structure and function of the device allows great control of axial movements while maintaining coaxial alignment of bones. Limb lengthening most often involves creation of an osteotomy perpendicular to the transport direction. Given the linear anatomy of extremities, the ring fixator is ideal in generating skeletal transport and fixation under an axial load.

Application of Ilizarov ring fixators with transcutaneous rods is not ideal in the facial region. The face concentrates many functions into overlapping anatomical units. Many anatomical structures are involved with multiple functions. Transfixation of skeletal elements with transcutaneous rods is generally not possible because of the interference with these other facial functions. In addition, esthetics is an important function of facial structures. Scarring of cosmetically important facial structures may result from external, transcutaneous devices.

Osteotomies necessary to mobilize facial bone fragments are complex in shape. The osteotomy is rarely perpendicular to the axis of transport. The transport geometry is therefore complex which complicates the determination of transport rate. As such, the response of the osteotomy to transport is also complex. The regeneration chambers in the orthopedic model differ from the maxillofacial model. The consolidation rate for facial bone transports may be affected by many factors. First, the complex morphology of the distraction chamber, second is the inherent difference in bone healing in the facial skeleton, and third is the effect of functional load on the consolidating site.

To allow practical, clinical use of distraction osteogenesis to intraoral and maxillofacial applications requires modification in both armamentarium and surgical technique. Direct application of Ilizarov’s distraction osteogenesis method is not possible in the maxillofacial region. This is because the facial bones differ from the extremities in morphology and function. The key is to incorporate the positive regenerative capability of orthopedic distraction osteogenesis into a practical method for facial bone reconstruction.