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Distraction Osteogenesis

Gradual bone lengthening through controlled mechanical traction

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Ağız ve Diş Sağlığı department. Book Appointment →

What is Distraction Osteogenesis?

Distraction osteogenesis is based on Ilizarov's principle of tension-stress, in which gradual traction (typically 0.5-1 mm per day) across a bone callus induces the formation of new bone (regenerate). The technique was first applied to long bones and then extended to craniofacial regions including mandible, maxilla, midface, alveolar ridge, and cranial vault.

Indications include severe mandibular hypoplasia (Pierre Robin sequence with airway obstruction, hemifacial microsomia, Treacher Collins syndrome), maxillary deficiency in cleft lip and palate, midface hypoplasia in syndromic craniosynostosis (Crouzon, Apert, Pfeiffer), alveolar ridge augmentation for implant placement, and craniofacial cleft repair. Compared to conventional osteotomy with bone grafting, DO achieves greater movement (up to 25-30 mm in mandible) with simultaneous soft tissue expansion.

Three phases define the protocol: latency (5-7 days post-osteotomy for callus formation), activation (gradual distraction at 1 mm/day in two daily increments), and consolidation (8-12 weeks for bone maturation before device removal). Internal (buried) and external (transcutaneous pin-based) distractors are available; internal devices reduce scarring but may be less precise. Postoperative imaging, clinical examination, and orthodontic coordination guide protocol adjustments.

Symptoms

Severe mandibular hypoplasia in infant (airway obstruction, feeding difficulty)
Pierre Robin sequence
Hemifacial microsomia
Treacher Collins syndrome
Maxillary deficiency in cleft lip and palate
Midface hypoplasia in craniosynostosis (Crouzon, Apert, Pfeiffer)
Severe class III malocclusion
Obstructive sleep apnea due to mandibular hypoplasia
Alveolar ridge atrophy preventing implant placement
Posttraumatic mandibular or maxillary deficiency
Failed conventional orthognathic surgery (relapse)
Cranial vault expansion for craniosynostosis
Dentofacial deformity with severe skeletal disproportion
Limb length discrepancy (orthopedic application)
Calvarial defects requiring expansion

Risk Factors

Severe craniofacial skeletal deficiency
Pierre Robin sequence with airway compromise
Hemifacial microsomia (Goldenhar spectrum)
Treacher Collins syndrome
Crouzon, Apert, Pfeiffer syndromes
Cleft lip and palate with severe maxillary hypoplasia
Failed conventional orthognathic surgery
Posttraumatic deformity
Tumor resection requiring reconstruction
Severe alveolar atrophy
Smoking (delayed regenerate maturation)
Diabetes mellitus (impaired healing)
Bisphosphonate use (osteonecrosis risk)
Radiation therapy history
Active infection or poor oral hygiene

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Newborn with severe mandibular hypoplasia and airway obstruction
  • Infant with Pierre Robin sequence and feeding difficulty
  • Child with hemifacial microsomia or syndromic craniosynostosis
  • Severe maxillary deficiency in cleft palate patient
  • Class III malocclusion with severe skeletal disproportion
  • Obstructive sleep apnea with maxillomandibular hypoplasia
  • Severe alveolar ridge atrophy planning implant placement
  • Failed prior orthognathic surgery with skeletal relapse
  • Posttraumatic skeletal deformity
  • Tumor resection requiring jaw reconstruction
  • Cranial vault deformity in craniosynostosis
  • Functional and esthetic concerns affecting quality of life

Treatment Methods

01
Comprehensive multidisciplinary evaluation by craniofacial surgeon, orthodontist, sleep medicine, and pediatric specialists
02
Detailed imaging with CBCT, 3D CT reconstruction, and cephalometric analysis
03
Polysomnography for obstructive sleep apnea
04
Virtual surgical planning with vector and trajectory determination
05
Patient-specific distractor design (CAD/CAM)
06
Internal versus external distractor selection based on age, anatomy, and goals
07
Mandibular distraction osteogenesis (MDO) for neonatal Pierre Robin
08
Bilateral mandibular distraction for hemifacial microsomia and Treacher Collins
09
Le Fort III distraction for syndromic midface hypoplasia
10
Le Fort I distraction for cleft maxillary advancement
11
Alveolar distraction for implant site preparation
12
Cranial vault distraction for craniosynostosis
13
Latency period 5-7 days postoperatively
14
Activation phase with 0.5-1 mm/day distraction (two daily increments)
15
Consolidation phase 8-12 weeks before device removal
16
Pin care and antibiotic prophylaxis for external devices
17
Frequent clinical and radiographic monitoring
18
Orthodontic coordination during and after distraction
19
Speech therapy for cleft and craniofacial patients
20
Postoperative orthognathic surgery occasionally for refinement
21
Long-term follow-up for skeletal stability and growth changes
22
Psychosocial support and family education throughout treatment

Which Department to Visit?

You can visit our Ağız ve Diş Sağlığı department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About Ağız ve Diş Sağlığı Department

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.