[Application of Ilizarov method in maxillofacial treatment]

Distraction osteogenesis is becoming the treatment of choice for the surgical correction of hypoplasias of the maxillofacial skeleton. The mandible can be elongated by intraoral or extraoral devices. The intraoral devices are smaller, do not leave an external scar and do not cause social inconvenience to the patient. The main disadvantages are less control of vector and the need for a second operation for removal. The most important factors of mandibular distraction are planning of distraction, location of the osteotomy, control of vector of lengthening and type of distraction device. In the maxilla, our experience with three types of maxillary distraction is discussed: 1) the rigid extraoral distraction, 2) the surgically assisted protraction and 3) the intraoral method. In the last years, distraction osteogenesis was applied in the treatment of obstructive sleep apnea. The method has several advantages over other methods, mainly in treatment of young children in order to improve airway and to decannulate tracheostomy. Alveolar distraction osteogenesis poses a new challenge in reconstructing atrophic alveolar bone with no need to harvest bone graft or to use bone substitutes. The advantages and problematic issues of alveolar distraction such as vector control of distraction are described. The intraoral method should always be considered first. However, in severely hypoplastic patients, when three-dimensional correction is necessary, the extraoral device has an advantage over the intraoral device. In the future, the issues to consider will be improvement of osteotomies by endoscopy, development of smaller multidirectional devices, improvement of bone quality by cytokines and growth factors in order to shorten the time of device bearing by the patients.