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8/6/2019 Mandibular Distraction Osteogenesis as a Method in Treating
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MANDIBULAR DISTRACTIONMANDIBULAR DISTRACTIONOSTEOGENESIS AS A METHOD INOSTEOGENESIS AS A METHOD IN
TREATING COMPLICATIONSTREATING COMPLICATIONS
ASSOCIATED WITH PIERRE ROBINASSOCIATED WITH PIERRE ROBIN
SEQUENCESEQUENCE
Sherif Amer Saad AmerSherif Amer Saad AmerA proposal for master degree inA proposal for master degree inoral and maxillofacial surgeryoral and maxillofacial surgery
Cairo UniversityCairo University
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Distraction OsteogensisDistraction Osteogensis
Ilizarov discovered two biologicalIlizarov discovered two biologicalprinciples of Distractionprinciples of DistractionOsteogenesis:Osteogenesis:
1.The tension stress effect on the genesis of
tissues.
2.The influence of blood supply and loading on
the shape of bones and joints.
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The first IlizarovThe first Ilizarovs principle postulates thats principle postulates that
gradual traction creates stress that cangradual traction creates stress that canstimulate and maintain regeneration ofstimulate and maintain regeneration ofliving tissues. The newly formed boneliving tissues. The newly formed boneremodels to conform to the boneremodels to conform to the bones naturals natural
structure.structure.
The second principle theorizes that theThe second principle theorizes that the
shape and mass of bones and joints areshape and mass of bones and joints aredependent upon an interaction betweendependent upon an interaction betweenmechanical loading and blood supply.mechanical loading and blood supply.
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Techniques of Distraction:Techniques of Distraction:
Callotasis (distractionofafracture callus):
Latency.
Distraction.
Consolidation.
Physeal distraction whichincludes:
Distraction epiphysiolysis.
Chondrodiatasis
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Glossoptosis Cleft palate
Retrognathia
PRS
Pierre Robin SequencePierre Robin Sequence
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Etiology:
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Complications of PRS:
Respiratory Problems:
Upper airway obstruction can cause hypoxia,
hypercapnia, cor-pulmonale, aspiration pneumonia
( early days of life).
Feeding Problem:
Failure to thrive, energy expenditure, and exhaustion,
cardiac failure, and ultimately death.
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ManagementManagement
Non-surgical Prone positioning.
High-flow nasal
cannula.
Special head caps toextend the neck.
Head traction.
Feeding devices (NGT) .
nasopharyngeal orendotracheal tube
SurgicalSurgical
Tongue traction suture.
lip-tongue adhesion(glossopexy).
Subperiosteal releaseof tongue musculature.
Transmandibular K-wire.
Tracheostomy
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New treatmentNew treatment
Distraction
osteogenesis by
Gradual
advancement of the
osteotomised
mandible addresses
the root of the
problem.
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AIM OF THE STUDYAIM OF THE STUDY
To evaluate the efficacy ofTo evaluate the efficacy of
mandibular DO in the correctionmandibular DO in the correction
of complications associated withof complications associated with
Pierre Robin Sequence. And toPierre Robin Sequence. And to
implement certain parameters ofimplement certain parameters of
study compatible with patientsstudy compatible with patients
young age.young age.
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Twelve patients regardless of the
sex presented with Pierre Robin
Sequence will be selected for the
study from the Oral and MaxillofacialSurgery Department, Nasser
Institute Hospital.
Selected patients will be divided into
two groups,
Group I: Neonates (up to 28 days).
Group II: Infants up to two year.
PATIENTS AND METHODSPATIENTS AND METHODS
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1. History and Clinical examination.
2. Surgical technique:
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3. Follow-up:1. Pulse oximetry readings will be
obtained preoperatively andpostoperatively.
2. Parameters of distraction: Latency period : 48 hours.
Distraction rate : 1 mm. every12 hours.
Distraction period : 20 days.
3. Traction tongue suture decreasedgradually according to the pulseoximeter reading. It was removedcompletely after ensuring proper
readings (above 94%).4. A questionnaire will be adapted to
evaluate aerodigestive mechanisms.
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