Mandibular Distraction Osteogenesis as a Method in Treating

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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Mandibular Distraction Osteogenesis as a Method in Treating

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