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The evaluation of bony union after frontofacial distraction.
J Craniofac Surg. 2009 Mar; 20(2):275-8.JC

Abstract

Frontofacial advancement by distraction osteogenesis using the rigid external distraction device has become an accepted treatment for the deformity associated with craniofacial dysostoses (e.g., Crouzon, Apert, and Pfeiffer syndromes). The technical and physiological principles of osteogenesis distraction are well understood. This study documents the pattern of calcification at the osteotomy sites after distraction by analysis of serial three-dimensional computed tomography (CT) scans. The CT scans of 25 patients (11 with Crouzon, 6 with Apert, and 8 with Pfeiffer syndrome) were analyzed. Eleven individual areas along the osteotomy lines were assessed for evidence of bone formation. Scores were assigned within 4 categories ranging from no bone, calcification without bridge formation, a bony bridge, to complete bony infill (>95%). The scans were reviewed on 2 separate occasions by 2 independent assessors. There was high concordance both for intraobserver and interobserver scores. Rigid external distraction frame removal was undertaken after a 6-week consolidation period. All CT scan timings were calculated from this date. Of the 25 patients studied, 16 patients had CT scans available at 3 to 6 months, 12 at 9 to 12 months, and 7 at or more than 18 months. The scans were available in standard coronal slices with three-dimensional reconstructions. Bone formation is most consistently seen in the pterygoid region with calcification consistently occurring earlier and more completely in this area. Bone formation was often delayed in the orbital region and severely delayed or absent in the frontal region and zygomatic arches. There was no significant difference in the order or quality of bony union for the 3 underlying craniofacial dysostoses. This preliminary study confirms the clinical impression that bone formation after distraction is greatest in the pterygoid regions. The clinical implications of these findings are discussed.

Authors+Show Affiliations

Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom. Karen.a.eley@gmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

19258910

Citation

Eley, Karen A., et al. "The Evaluation of Bony Union After Frontofacial Distraction." The Journal of Craniofacial Surgery, vol. 20, no. 2, 2009, pp. 275-8.
Eley KA, Witherow H, Hayward R, et al. The evaluation of bony union after frontofacial distraction. J Craniofac Surg. 2009;20(2):275-8.
Eley, K. A., Witherow, H., Hayward, R., Evans, R., Young, K., Clark, A., & Dunaway, D. (2009). The evaluation of bony union after frontofacial distraction. The Journal of Craniofacial Surgery, 20(2), 275-8. https://doi.org/10.1097/SCS.0b013e31819921b2
Eley KA, et al. The Evaluation of Bony Union After Frontofacial Distraction. J Craniofac Surg. 2009;20(2):275-8. PubMed PMID: 19258910.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The evaluation of bony union after frontofacial distraction. AU - Eley,Karen A, AU - Witherow,Helen, AU - Hayward,Richard, AU - Evans,Robert, AU - Young,Karen, AU - Clark,Allan, AU - Dunaway,David, PY - 2009/3/5/entrez PY - 2009/3/5/pubmed PY - 2009/8/13/medline SP - 275 EP - 8 JF - The Journal of craniofacial surgery JO - J Craniofac Surg VL - 20 IS - 2 N2 - Frontofacial advancement by distraction osteogenesis using the rigid external distraction device has become an accepted treatment for the deformity associated with craniofacial dysostoses (e.g., Crouzon, Apert, and Pfeiffer syndromes). The technical and physiological principles of osteogenesis distraction are well understood. This study documents the pattern of calcification at the osteotomy sites after distraction by analysis of serial three-dimensional computed tomography (CT) scans. The CT scans of 25 patients (11 with Crouzon, 6 with Apert, and 8 with Pfeiffer syndrome) were analyzed. Eleven individual areas along the osteotomy lines were assessed for evidence of bone formation. Scores were assigned within 4 categories ranging from no bone, calcification without bridge formation, a bony bridge, to complete bony infill (>95%). The scans were reviewed on 2 separate occasions by 2 independent assessors. There was high concordance both for intraobserver and interobserver scores. Rigid external distraction frame removal was undertaken after a 6-week consolidation period. All CT scan timings were calculated from this date. Of the 25 patients studied, 16 patients had CT scans available at 3 to 6 months, 12 at 9 to 12 months, and 7 at or more than 18 months. The scans were available in standard coronal slices with three-dimensional reconstructions. Bone formation is most consistently seen in the pterygoid region with calcification consistently occurring earlier and more completely in this area. Bone formation was often delayed in the orbital region and severely delayed or absent in the frontal region and zygomatic arches. There was no significant difference in the order or quality of bony union for the 3 underlying craniofacial dysostoses. This preliminary study confirms the clinical impression that bone formation after distraction is greatest in the pterygoid regions. The clinical implications of these findings are discussed. SN - 1536-3732 UR - https://www.unboundmedicine.com/medline/citation/19258910/The_evaluation_of_bony_union_after_frontofacial_distraction_ DB - PRIME DP - Unbound Medicine ER -