Research Article| Volume 46, ISSUE 3, P201-207, 1993

Midface advancement by gradual distraction

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      Midface osteotomy was performed on 5 young adult sheep aged 10–12 months.In 4 animals midface advancement by gradual distraction was performed using an external device; one animal served as a control. The midface was advanced by 2 mm per day for 21 days. The amount of advancement was 36 mm in the nasofrontal area and 43 mm on the lateral aspect of the maxilla. After the period of active distraction the midface was maintained with external fixation for an additional 6 weeks to allow for ossification. Radiographs were obtained immediately postoperatively, after 21 days of distraction, and at the end of the 6 week fixation period. New bone formation in the distracted area was obvious radiographically, clinically and histologically.
      In conclusion, midface advancement by osteotomy and gradual distraction is possible in the sheep model and may offer controlled correction of deformity, obviating the need for bone grafting.


        • Bell W.H.
        • Scheideman C.B.
        Correction of vertical maxillary deficiency: stability and soft tissue changes.
        Journal of Oral Surgery. 1981; 39: 666
        • Codivilla A.
        On the means of lengthening in the lower limbs, muscles and tissues which are shortened through deformity.
        American Journal of Orthopaedics Surgery. 1905; 2: 353
        • Constantino P.D.
        • Shybut G.
        • Friedman C.D.
        • Pelzer H.J.
        • Masini M.
        • Shindo M.L.
        • Sisson G.A.
        Segmental mandibular regeneration by distraction osteogenesis.
        Archives of Otolaryngology Head Neck Surgery. 1990; 116: 535
        • De Bastiani G.
        • Oldegheri R.
        • Ranzi-Brivio L.
        • Trivella G.
        Limb lengthening by callus distraction (callostasis).
        Journal of Pediatric Orthopaedics. 1987; 7: 129
        • Delloye C.
        • Delefortrie G.
        • Coutelier L.
        • Vincent A.
        Bone regenerate formation in cortical bone during distraction lengthening: an experimental study.
        Clinical Orthopaedics and Related Research. 1990; 250: 34
        • Hedemark A.
        • Freihofer H.P.
        The behaviour of the maxilla in vertical movements after Le Fort I osteotomy.
        Journal of Maxillofacial Surgery. 1978; 6: 244
        • Ilizarov G.A.
        The principles of the Ilizarov method.
        Bulletin of the Hospital for Joint Diseases Orthopaedic Institute. 1988; 48: 1
        • Ilizarov G.A.
        • Devyatov A.A.
        • Karnerim V.K.
        Plastic reconstruction of longitudinal bone defects by means of compression and subsequent distraction.
        Acta Chirugia Plastica. 1980; 22: 32
        • Jackson I.T.
        Maxillary hypoplasia.
        Clinics in Plastic Surgery. 1989; 16: 769
        • Karaharju T.
        • Karaharju E.O.
        • Ranta R.
        Mandibular distraction: an experimental study on sheep.
        Journal of Cranio-maxillofacial Surgery. 1990; 18: 280
        • Karp N.S.
        • Thorne C.H.M.
        • McCarthy J.G.
        • Sissons H.A.
        Bone lengthening in the craniofacial skeleton.
        Annals of Plastic Surgery. 1990; 24: 231
        • Kojimoto H.
        • Yasui N.
        • Goto T.
        • Matsuda S.
        • Shimomura Y.
        Bone lengthening in rabbits by callus distraction: the role of periosteum and endosteum.
        Journal of Bone and Joint Surgery. 1988; 70B: 543
        • Laurie S.W.
        • Kaban L.B.
        • Mulliken J.B.
        • Murray J.E.
        Donor site morbidity after harvesting rib and iliac bone.
        Plastic and Reconstructive Surgery. 1984; 73: 933
        • Luyk N.H.
        • Ward-Booth R.P.
        The stability of Lefort I advancement osteotomies using bone plates without bone grafts.
        Journal of Maxillofacial Surgery. 1985; 13: 250
        • McCarthy J.G.
        • Schreiber J.
        • Karp N.
        • Thorne C.H.
        • Grayson B.H.
        Lengthening the human mandible by gradual distraction.
        Plastic and Reconstructive Surgery. 1992; 89: 1
        • Michieli S.
        • Miotti B.
        Lengthening of mandibular body by gradual surgical-orthodontic distraction.
        Journal of Oral Surgery. 1977; 35: 187
        • Paley D.
        • Catagni M.A.
        • Argnani F.
        • Villa A.
        • Benedetti G.B.
        • Cattaneo R.
        Ilizarov treatment of tibial nonunions bone loss.
        Clinical Orthopaedic and Related Research. 1989; 241: 146
        • Persson G.
        • Hellen S.
        • Nord P.G.
        Bone plates for stabilizing Le Fort I osteotomies.
        Journal of Maxillofacial Surgery. 1986; 14: 69
        • Phillips J.H.
        • Forrest C.R.
        • Gruss J.S.
        Current concepts in the use of bone grafts in facial fractures.
        Clinics in Plastic Surgery. 1992; 19: 41
        • Remmler D.
        • McCoy F.J.
        • O'Neil D.
        • Willoughby L.
        • Patterson B.
        • Gerald K.
        • Morris D.C.
        Osseous expansion of the cranial vault by craniostasis.
        Plastic and Reconstructive Surgery. 1992; 89: 787
        • Snyder C.C.
        • Levine G.A.
        • Swanson H.M.
        • Browne Jr, E.Z.
        Mandibular lengthening by gradual distraction.
        Plastic and Reconstructive Surgery. 1973; 51: 506
        • Steinhauser E.W.
        Variations of Le Fort II osteotomies for correction of midfacial deformities.
        Journal of Maxillofacial Surgery. 1980; 8: 258