Distraction osteogenesis in the treatment of dentofacial deformities

Distraction osteogenesis (DO) is a major surgical technique that promotes new bone formation. It was first developed in the long bones and has now been applied to the facial bones. McCarthy et al. were the first to apply the procedure to the human mandible. The early uses in craniofacial surgery and orthognathic surgery were with extraoral appliances and therefore had limited appeal to many patients other than those with severe craniofacial anomalies, such as hemifacial microsomia. This changed with the introduction of intraoral appliances. Since that time, the use of DO has expanded to applications beyond those in jaw and craniofacial abnormalities to include its use in the treatment of cleft palate patients, condylar regeneration, discontinuity defects of the mandible, and for ridge augmentation before the placement of implants. Moreover, as experience in treating severe dentofacial deformities increased, surgeons were encouraged to intercede at an earlier age to minimize the extent of the deformity and to minimize relapse after surgery. This article describes some of the newer concepts in using DO to treat maxillary and mandibular deformities and growth discrepancies that are not amenable to routine orthognathic surgery.