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Natl J Maxillofac Surg. 2015 Jul-Dec; 6(2): 135.
PMCID: PMC4922221

Distraction histogenesis: The way ahead

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Maxillary and/or mandibular deformities alone or in combination are quite frequently encountered in our practice. The burden of the problem is superadded due to a lot many patients with clefts reporting to us late when the deformity has established. Temporomandibular joint ankylosis also takes its toll, adding to the need to deal with these developmental deformities.

Correction of maxillary and mandibular deformities and bringing them into acceptable skeletal and occlusal relationship are desirable. Orthognathic procedures and various osteotomies, Lefort 1, Lefort 3, Lefort 2, or segmental osteotomies are being regularly done. However, when the desired movement is considerable (more than 10 mm advancement of maxilla, and also for mandible), distraction histiogenesis is perhaps the only way out. Such large advancements are limited by the restrictions due lack of the soft tissue envelope to stretch beyond a certain degree. When gradual distraction forces are applied across the osteotomy, not only the callus elongates but also the soft tissues grow in response to mechanical stress (mechanostat hypothesis). The soft tissue grows pari passu (hyperplasia occurs) and is not just merely stretched. Hence, the term is “distraction histiogenesis.” The advantage is that large advancements can be performed safely, without the restrictions of soft tissue envelope. Vessels, nerves too respond with hyperplasia. Complex three dimensional deformities can be corrected by multiplanar distractors. Simultaneous correction of maxillary and mandible having occlusal cant is also amenable to treatment. The risk of relapse is minimized. Furthermore, if need be, the procedure can be repeated. Surgery itself may be easier, less time-consuming, and safer than an on-site osteotomy, advancement, and plating. Having brought the basic facts to force, distraction histiogenesis is not utilized in our practice to the extent it ought to be. The reasons may be many. First and foremost is the inertia on the part of the surgeons to accept it as a tool to correct dentofacial deformities. The proper planning of vector is perhaps also a deterring factor. Nonavailability of good distracters is also a big issue. Uniplanar stainless distracters are how readily available in the market. However, lightweight titanium or other alloy distracters are still a far cry. Precision multiplanar distractors are simply not available. The ones imported is prohibitively expensive. We tried to locally fabricate on halo type external distractor for the maxilla, made of lightweight aluminum. We realized that it was very difficult. Once again, the rigid external distractor device is not made in India and is beyond the purchase capability of most institutions and individuals. The medical instrument manufacturing industry needs to respond. The need for these devices exists and due to its nonavailability, the surgeons also not feel confident to use those devices.

The same holds true (even to a greater extent) for craniofacial distractions. The plastic surgery fraternity and the oral and maxillofacial fraternity need to be proactive on these issues, all in the interest of the patient – to give him/her long-lasting results that too safely and surely.


Articles from National Journal of Maxillofacial Surgery are provided here courtesy of Wolters Kluwer -- Medknow Publications