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Long-term Results

Maj Peter D. Costantino, MC, USAF; Craig D. Friedman, MD; Maise L. Shindo, MD; Col Glenn Houston, MC, USAF; George A. Sisson, Sr, MD

Arch Otolaryngol Head Neck Surg. 1993;119(5):511-516.

Abstract
• The use of gradual distraction to grow bone (distraction osteogenesis) has gained widespread orthopedic acceptance, but has only recently been applied to craniofacial skeletal defects. The use of bifocal distraction osteogenesis to fill experimental segmental mandibular defects with regenerate bone was recently reported. Though all canines in that study demonstrated normal oromandibular function, they were observed for only 4 weeks following defect closure. The study that is now reported describes the long-term (12-month) functional, morphologic, and biomechanical results when bifocal distraction osteogenesis was applied to the same model. In this long-term study, three canines had 2.5-cm unilateral segmental mandibular body defects filled with structurally stable bone using bifocal distraction osteogenesis. These dogs exhibited normal oromandibular function for 1 year following segment regrowth and external fixator removal. Macroscopic and histologic evaluation of the regrown segments revealed a re-formation of the cortical and medullary architecture. Stress testing demonstrated the average ultimate strength of the regrown segment at 53 MPa, which corresponded to 77%±5.7% of normal mandibular bone. The data suggest that clinical trials applying this technique to segmental mandibular reconstruction are warranted.

(Arch Otolaryngol Head Neck Surg. 1993;119:511-516)

Author Affiliations
From the Departments of Otolaryngology—Head and Neck Surgery, Loyola University Stritch School of Medicine, Maywood (Dr Costantino), and Northwestern University Medical School, Chicago (Dr Sisson), Ill; Departments of Otolaryngology—Head and Neck Surgery (Dr Costantino) and Oral Pathology (Dr Houston), Wilford Hall USAF Medical Center, Lackland Air Force Base, Tex; Department of Surgery, Section of Otolaryngology, Yale University School of Medicine, New Haven, Conn (Dr Friedman); and Department of Otolaryngology—Head and Neck Surgery, The University of Southern California School of Medicine, Los Angeles (Dr Shindo). None of the authors has any financial interest in Orthofix S.R.L., Verona, Italy.

Footnotes
Accepted for publication November 11, 1992.

Presented at the Surgical Forum of the 93rd Annual Clinical Congress of the American College of Surgeons, Chicago, III, October 22, 1991.

Reprint requests to Department of Otolaryngology—Head and Neck Surgery, Wilford Hall USAF Medical Center (WHMC/SGHSO), Lackland AFB, TX 78236 (Dr Costantino).

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