Distraction Osteogenesis in the Pediatric Population

OBJECTIVES: Distraction osteogenesis has been described routinely in the mandible for the advancement of bony segments. Complications, though infrequent, may include postoperative infection, implant extrusion, nonunion of the bony segments, device malfunction, cranial nerve paresis, and premature consolidation. METHODS: Seventy-eight distractions of the mandible were performed over 10 years. The technique in placement of these internal microdistraction devices involves making intraoral and extraoral incisions and beginning distraction after a latency period of 3 days. Following this latency period, distraction occurs at 1 mm/day. RESULTS: In this series of patients, distraction was accomplished successfully. There was a 2.6% rate of wound infection in this series; 2.6% also had bony nonunion; 3.8% had premature bony consolidation; and 3.8% had facial nerve complications. In the three patients with facial nerve paresis, we followed the facial nerve clinically and each paresis resolved within 6 months. CONCLUSIONS: Distraction of the mandible may be accomplished in the pediatric population. As with any intervention, inherent perioperative complications may still arise.

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Schwannomas

Oxford Textbook of Neurological Surgery ◽

10.1093/med/9780198746706.003.0022 ◽

2019 ◽

pp. 255-270

Author(s):

Tiit Mathiesen ◽

Petter Förander ◽

David Pettersson

Keyword(s):

Facial Nerve ◽

Cranial Nerve ◽

Cerebellopontine Angle ◽

Treatment Options ◽

Life Quality ◽

Intracranial Tumours ◽

Tumour Control ◽

Nerve Paresis

Sporadic vestibular schwannoma (VS) is the commonest tumour of the cerebellopontine angle and comprise 6–8% of all intracranial tumours. The incidence varies between 12 and 20 cases per million inhabitants and years in different reports; a large minority of these tumours grow during follow-up. Treatment options include wait and scan, microsurgery, radiosurgery, and radiotherapy. Micro- and radiosurgery are well validated to offer long-term tumour control, but patients may suffer from hearing deficit and facial nerve paresis. Unexpectedly, long-term life quality is more affected by vertigo and headaches. Other cranial nerve schwannomas cause symptoms depending on the affected nerves and respond to the same therapies when treatment is indicated.

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Postoperative Complications Following TECA-LBO in the Dog and Cat

Journal of the American Animal Hospital Association ◽

10.5326/jaaha-ms-5738 ◽

2013 ◽

Vol 49 (3) ◽

pp. 160-168 ◽

Cited By ~ 15

Author(s):

Rebecca E. Spivack ◽

A. Derrell Elkins ◽

George E. Moore ◽

Gary C. Lantz

Keyword(s):

Facial Nerve ◽

Medical Records ◽

Perioperative Complications ◽

Clinical Signs ◽

Head Tilt ◽

Horner’S Syndrome ◽

Ear Canal ◽

Horner's Syndrome ◽

Significant Difference ◽

Nerve Paresis

The medical records for 133 total ear canal ablations combined with lateral bulla osteotomies (TECA-LBOs) performed on 82 dogs (121 ears) and 11 cats (12 ears) between 2004 and 2010 were reviewed to determine if the duration of preoperative clinical signs was associated with the incidence of postoperative facial nerve injury and Horner's syndrome. Other perioperative complications, such as a head tilt, nystagmus, incisional drainage, draining tracts, hearing loss, as well as bacterial culture results, were noted. Postoperative facial nerve paresis occurred in 36 of 133 ears (27.1%), and paralysis occurred in 29 of 133 ears (21.8%), with no significant difference between species. Thus, postoperative facial nerve deficits occurred in 48.9% of ears. The median duration of clinically evident temporary facial nerve deficits was 2 wk for dogs and 4 wk for cats. Dogs had a significantly longer duration of preoperative clinical signs and were less likely than cats to have a mass in the ear canal. Dogs were less likely to have residual (> 1 yr) postoperative facial nerve deficits. The incidence of postoperative Horner's syndrome was significantly higher in cats than dogs. The duration of preoperative clinical signs of ear disease was not associated with postoperative facial nerve deficits.

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Facial nerve outcome after acoustic neuroma surgery: A study from the era of cranial nerve monitoring

Otolaryngology ◽

10.1016/s0194-5998(94)70522-4 ◽

1994 ◽

Vol 111 (5) ◽

pp. 561-570 ◽

Cited By ~ 49

Author(s):

A LALWANI ◽

F BUTT ◽

R JACKLER ◽

L PITTS ◽

C YINGLING

Keyword(s):

Facial Nerve ◽

Acoustic Neuroma ◽

Cranial Nerve ◽

Nerve Monitoring ◽

Acoustic Neuroma Surgery

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CLINICAL AND ELECTROMYOGRAPHIC PREDICTION OF FACIAL NERVE NEUROPATHY IN CHILDREN

JOURNAL OF NEUROLOGY AND NEUROSURGICAL RESEARCH ◽

10.26739/2181-0982-2020-3-7 ◽

2020 ◽

Vol 3 (1) ◽

pp. 38-40

Author(s):

Nozima Asadova ◽

◽

Aziza Djurabekova ◽

Saodat Igamova

Keyword(s):

Facial Nerve ◽

Children And Adolescents ◽

Medical Literature ◽

Latency Period ◽

Pain Syndrome ◽

Literature Discussions ◽

Clinical Forms ◽

Diagnosis And Prognosis ◽

Neurological Features ◽

Blinking Reflex

In modern medical literature, discussions continue about neuropathies of the facial nerve in children,disease factors, clinical and neurological features, the severity of the course, the difficulties of diagnosis and prognosis of the disease. The work is devoted to the analysis of the neuropathy of the facial nerve in children and adolescents, depending on the clinical forms of the disease, using electroneurosympathetic indicators, the latency period, the blinking reflex and thenatureof the lesion of the facial nerve accompanied by pain syndrome

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Long-term recurrence rate of pleomorphic adenoma and postoperative facial nerve paresis (in parotid surgery)

Journal of Cranio-Maxillofacial Surgery ◽

10.1016/j.jcms.2007.02.003 ◽

2007 ◽

Vol 35 (3) ◽

pp. 189-192 ◽

Cited By ~ 30

Author(s):

Oliver Zernial ◽

Ingo N. Springer ◽

Patrick Warnke ◽

Franz Härle ◽

Christian Risick ◽

...

Keyword(s):

Facial Nerve ◽

Pleomorphic Adenoma ◽

Recurrence Rate ◽

Parotid Surgery ◽

Nerve Paresis ◽

Long Term Recurrence Rate

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Automating Skeletal Expansion: An Implant for Distraction Osteogenesis of the Mandible

Journal of Medical Devices ◽

10.1115/1.3071969 ◽

2009 ◽

Vol 3 (1) ◽

Cited By ~ 6

Author(s):

John C. Magill ◽

Marten F. Byl ◽

Batya Goldwaser ◽

Maria Papadaki ◽

Roger Kromann ◽

...

Keyword(s):

Distraction Osteogenesis ◽

Treatment Time ◽

Patient Activation ◽

Latency Period ◽

Bone Lengthening ◽

Loop Control ◽

New Device ◽

Distraction Device ◽

Component Failures ◽

Natural Healing

Distraction osteogenesis is a technique of bone lengthening that makes use of the body’s natural healing capacity. An osteotomy is created, and a rigid distraction device is attached to the bone. After a latency period, the device is activated two to four times per day for a total of 1 mm/day of bone lengthening. This technique is used to correct a variety of congenital and acquired deformities of the mandible, midface, and long bones. To shorten the treatment period and to eliminate the complications of patient activation of the device, an automated continuous distraction device would be desirable. It has been reported that continuous distraction generates adequate bone with lengthening at a rate of 2 mm/day, thereby reducing the treatment time. The device we describe here uses miniature high-pressure hydraulics, position feedback, and a digital controller to achieve closed-loop control of the distraction process. The implanted actuator can produce up to 40 N of distraction force on linear trajectories as well as curved distraction paths. In this paper we detail the spring-powered hydraulic reservoir, controller, and user interface. Experiments to test the new device design were performed in a porcine cadaver head and in live pigs. In the cadaver head, the device performed an 11 day/11 mm distraction with a root-mean-squared position error of 0.09 mm. The device functioned for periods of several days in each of five live animals, though some component failures occurred, leading to design revisions. The test series showed that the novel design of this system provides the capabilities necessary to automate distraction of the mandible. Further developments will focus on making the implanted position sensor more robust and then on carrying out clinical trials.

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Facial Nerve Dysfunction After Mandibular Distraction Osteogenesis in Patients with Robin Sequence: A Systematic Review and Meta-Analysis

The Cleft Palate-Craniofacial Journal ◽

10.1177/10556656211070728 ◽

2022 ◽

pp. 105566562110707

Author(s):

Elina Kapoor ◽

Esperanza Mantilla-Rivas ◽

Md Sohel Rana ◽

Marudeen Aivaz ◽

Daniela Duarte-Bateman ◽

...

Keyword(s):

Systematic Review ◽

Facial Nerve ◽

Distraction Osteogenesis ◽

Meta Analysis ◽

Mandibular Distraction ◽

Robin Sequence ◽

Published Evidence ◽

Mandibular Distraction Osteogenesis ◽

Nerve Dysfunction ◽

Distraction Rate

Objective Robin Sequence (RS), characterized by micrognathia, glossoptosis, and upper airway obstruction, is an increasingly recognized diagnosis. An effective surgical intervention is mandibular distraction osteogenesis (MDO). This study analyzes published evidence regarding facial nerve dysfunction (FND) associated with MDO. Design and Setting According to PRISMA guidelines, a systematic review was carried out with databases queried in June 2019 using MESH terms, or equivalent terms, as follows: “distraction osteogenesis” and “Robin Sequence”. A review of original Spanish and English articles, were included. Outcome measures included the prevalence of FND; the affected branches; the rate of permanent vs. transient FND; the use of an internal vs. external device; the daily distraction rate; and finally, the overall distraction length. Subsequently, a meta-analysis was conducted to collate results regarding the prevalence of FND and the factors associated with it. Results Of 239 unique studies identified, 19 studies with 729 patients met inclusion criteria; 52 patients developed FND after MDO. A random-effects meta-analysis yielded a pooled prevalence of FND of 6.40%, with moderately heterogeneous studies (I2 = 41%, τ2 = 0.006). Marginal mandibular nerve involvement was most commonly noted. Nine studies reported transient FND, six permanent, one both, and two unspecified. Internal distractors were used in 8 studies and external in 3 and both in 2. Distraction rate was 1.00 to 2.00 mm/day and total distraction length ranged from 13.00 to 22.3 mm. Sample size was the only parameter inversely associated with rate of FND (p = 0.04). Conclusion This analysis of FND associated with MDO for patients with RS demonstrates a lack of consistent documentation. MDO-associated FND does not appear to be uncommon, and permanent dysfunction can occur. This review underscores the importance of thorough documentation to elucidate the mechanism of FND.

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