Home | About us | Editorial board | Ahead of print | Current issue | Archives | Search | Submit article | Instructions | Subscribe | Advertise | Contact us |  Login 
National Journal of Maxillofacial Surgery
 
Print this page Email this page Small font sizeDefault font sizeIncrease font size
Users Online: 386
 


 
Table of Contents
EDITORIAL
Year : 2015  |  Volume : 6  |  Issue : 2  |  Page : 135  

Distraction histogenesis: The way ahead


Department of Plastic Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India

Date of Web Publication10-Jun-2016

Correspondence Address:
Arun Kumar Singh
Department of Plastic Surgery, King George's Medical University, Lucknow, Uttar Pradesh
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-5950.183861

Rights and Permissions

How to cite this article:
Singh AK. Distraction histogenesis: The way ahead. Natl J Maxillofac Surg 2015;6:135

How to cite this URL:
Singh AK. Distraction histogenesis: The way ahead. Natl J Maxillofac Surg [serial online] 2015 [cited 2019 Nov 20];6:135. Available from: http://www.njms.in/text.asp?2015/6/2/135/183861










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.




 

Top
   
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article

 Article Access Statistics
    Viewed1461    
    Printed32    
    Emailed0    
    PDF Downloaded8521    
    Comments [Add]    

Recommend this journal