A clinical study on the effect of new curved paediatric segment transfer distraction osteogenesis for symphyseal mandibular reconstruction

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Abstract

Aim of the study

The aim of this study was to evaluate the effect of a new curved paediatric segment transfer distraction osteogenesis technique in the reconstruction of symphyseal mandibular defect.

Patient and methods

A new segment transfer distractor has been made from stainless steel. The main railway track is made as a hollow tube taking the shape of the mandible, guided by a face impression of the patient in plaster. This railway track was fixed to the remaining mandibular stump by means of a custom-made miniplate. The transfer segment was fixed to the device by means of another miniplate. Traction mechanism is the method for transforming force to get the segment part to move. After a 5-day latent period, the bone was distracted and activation at a rate of 2 mm/day was carried out, followed by a consolidation period. A custom-made electrical stimulator device was fabricated with microtransistors and resistors, in a circuit with 9 V battery, to produce a direct current of 10 μA continuously. Patients were asked to wear the device continuously for a minimum of 12 h.

Patient and methods

The distraction wound was evaluated during early activation, late activation, early consolidation, late consolidation and 12 months postoperatively. Ultrasound examination was performed. Occlusal images were taken at the first, fourth, eighth and 12th week after traction to check the accurate curved shape of the regenerate. Bone density of the distraction zone on the digital panoramic radiographs were analysed using Gray scale analyser

Results

This study showed that a curved mandibular symphyseal defect could be reconstructed by transport distraction. The shape of the distracted mandibular bone was almost symmetrical to the other nondistracted half.

Results

Gross examination of the distracted bone at the time of device removal revealed new bone formation, which could not be differentiated from the adjacent native bone.

Conclusion

Reconstruction of mandibular symphyseal defects in children is extremely challenging because of the anatomy of their mandibles. There have been few, if any, clinical reports on the use of an internal distractor to cure mandibular symphyseal defects in children. Compared with the currently used external distractor, an internally fixed distractor may be more comfortable for patients, and thus we designed an internal distractor that could be used in these paediatric defects.

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