PMID: 10697176

Issn Print: 0032-1052

Publication Date: 2000/02/01


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Manipulation of Callus after Linear Distraction: A “Lifeboat” or an Alternative to Multivectorial Distraction Osteogenesis of the Mandible?

Christoph Kunz; Beat Hammer; Joachim Prein

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Through the basic work of McCarthy et al., 1,2 Molina and Ortiz Monasterio, 3 Ortiz Monasterio et al., 4 and others, 5–7 distraction osteogenesis has become a standard tool for managing severe mandibular deformities with impressive results. Nevertheless, many unanswered questions remain concerning optimal latency and distraction rate, reduction of consolidation time and—as a problem of paramount interest—control of distraction vectors, especially when completely buried devices are used to avoid external scars and to provide the patient with more comfort during the distraction and consolidation period.
Vector control in multidimensional mandibular distraction is difficult, and the result may differ significantly from the planning. 8–10 Because of the action of masticatory muscles, the distraction axis tends to deviate from the original treatment plan toward an open bite. 8 Even multidirectional devices, which allow adjustments during the distraction period, do not completely solve this problem. By using occlusal elastics during or after distraction, it has been possible to correct minor deviations of the distraction vector from the preplanned axis 11 or to avoid occlusal discrepancies after simultaneous mandibular and maxillary distraction. 4 Pensler et al. were the first to report on direct manual reshaping of the callus for minor adjustments after distraction. 9 However, despite good occlusal results, it has not been possible to effectively correct the obtuse gonion angle characterizing severe mandibular hypoplasia. Furthermore, with submerged distraction devices, even if multiplanar, it will be difficult if not impossible to correct a severe mandibular deformity anatomically, because length and geometrical flexibility are limited and insufficient for major corrections of the three-dimensional shape.
In this report we review our experience with extensive manipulation of the callus in two patients. In both patients, linear distraction had resulted in a severe open bite. A manual shaping of the callus was performed immediately after distraction, decreasing the gonion angle by 26 degrees in one patient and by 20 degrees in the other and creating a more anatomic shape for the mandibular angle. In addition to being a salvage procedure for loss of vector control, the possibility of virtually free molding of the callus seems to offer interesting perspectives in the treatment of complex mandibular deformities.

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