Richard Burton, DDS, MS, Professor of Oral and
University of Iowa College of Dentistry
First Published: May 2001
Last Revised: May 2001
Peer Review Status: Internally Peer Reviewed
Distraction osteogenesis is a new variation of more traditional
orthognatic surgical procedures for the correction of dental facial
deformities. It is most commonly used for the correction of more
severe deformities and syndromes that were untreatable in the past.
It can be applied to both the maxilla and the mandible and can be
used in children at ages previously untreatable. It has shown
excellent results with both predictability and stability of
What is the recovery time like?
The recovery period is determined by the jaw in which the surgery
is done and the type of device utilized for the distraction.
Hospitalization is usually only overnight, and the period of both
distraction and retention can be completed at home with the person
maintaining a nearly normal lifestyle.
Can children have this procedure done, if they have a malformed
Children can have these procedures done. We are currently
performing the surgery on children in the lower jaw at under 1 year
of age and in the upper jaw between the ages of 7 and 10 years
Is this considered a "risky" procedure? Any risk of nerve
As with any major surgical procedure, there are risks associated
with it....but in many situations these risks are outweighed by the
improvement in the quality of life and function corrected by the
surgery. There is in the lower jaw risk of nerve damage, but this is
lower than more conventional methods and the regenerative properties
of the nerve are higher in infants and children.
Is it necessary for the jaw to be wired shut afterward?
No, in both maxillary and mandibular distraction, the patient is
not wired shut. The patient has movement of the jaws but does not
have normal chewing function and usually is maintained on either a
liquid or soft-chew diet during the distraction period.
How long does this procedure take, and what is the recovery
Depending on the jaw in which the surgery takes place and whether
one or both sides is involved, the surgeries run between 1.5 and 4
hours. After an overnight admission to the hospital, the patients are
discharged home. Initial recovery period is approximately 5 days,
during which the distraction is started and continued. Distraction
periods usually run between 10 and 20 days during which time the
patient can resume a normal lifestyle with somewhat reduced physical
activity. Active distraction is followed by a period of 6-8 weeks of
retention after which the distraction devices are removed and
treatment is complete.
What is the age of the youngest patient you have
For lower jaw distraction, I have treated patients as young as 10
months and will be treating a 4-month-old next month. These surgeries
are all in the lower jaw. The youngest upper jaw distraction has been
8 years old.
What kind of facial deformities can be fixed through this
These procedures can be used to treat a wide range of facial
deformities but it is most appropriate in syndromic patients and
children with conditions such as cleft palate, severe asymmetry,
severe mandibular hypoplasia with resulting airway compromise, facial
clefts, Treacher-Collins syndrome, Pierre-Robin sequence and
Would there be any visible scars?
Upper jaw distraction utilizes a rigid external halo that produces
minimal scarring and is well hidden in the hairline. Lower jaw
distraction can be both intraoral and extraoral. In most cases,
scarring is present but not severe.
With this in young children, will their jaw still grow
There appears to be growth potential in these children though in
most cases they will still not grow adequately. They may require
further surgery to more fully correct their deformity and establish a
more functional occlusion.
Would there be a lot of swelling afterward?
Patients exhibit minimal swelling after the procedure, the
majority of which resolves within 7 to 10 days, though there is some
residual swelling until after completion of the distraction phase of
What kind of follow up with the doctor is needed after this
After completion of surgery and discharge home, the device will be
activated between 2 and 5 days after surgery. The patient will be
closely monitored during the active phase of distraction with
follow-up every 3 to 5 days. After the completion of the distraction,
the patient is seen every 1 or 2 weeks during the retention phase of
treatment...and then monthly for 3 to 6 months.
What kind of questions should I ask my doctor before this
The kind of questions that should be asked should include a
decision regarding treatment goals for distraction and the
appropriateness and ability of distraction to reach that goal, what
type of device will be used, how long will the device need to be worn
for both distraction and retention, are other retention devices
necessary after removal of the device and how long must they be worn,
what type of similar patients have been done and what have their
treatment outcomes been, does the device have FDA approval and how
long has it been available on the market, what is the doctor's
experience in treating these types of patients, and what possible
alternatives are there to distraction.
How do I know if I am a candidate?
The determination for the appropriateness of distraction as a
treatment modality hinges primarily upon the severity and type of
deformity and the ability of other means of treatment in being able
to adequately correct it. Distraction is not a treatment of last
resort but is most appropriate for the more severe types of
deformities or patients who require treatment at an early age, which
is inappropriate for more conventional therapy.
Many times, distractions can be used as an interventional
treatment in childhood to allow more normal growth and development
and prevent many other developmental delays and complications. We
have had a great deal of success in the treatment of severely
hypoplastic mandibular development in children. The majority of these
children have been tracheostomy-dependent since birth. Many times,
they remained tracheostomy-dependent until their teen years, when
more conventional treatment was possible. Being able to eliminate
their tracheostomy prior to the beginning of development of speech
allows a more normal childhood and development with a better quality
of life and health and reduced total medical care costs for the
patient and family.
The use of maxillary distraction, particularly in the cleft palate
population, has allowed us to achieve levels of correction that are
unattainable by other methods. Through distraction, midface
deficiency can be corrected to a normal position. In the past, we
often camouflaged our results by treating both the upper and lower
jaws, because we were unable to perform the correction adequately in
the upper jaw.
Is this special training needed to perform this
Also, we can correct maxillary position at a younger age,
normalizing occlusion and allowing for more normal midface growth
after the completion of distraction. The basis for both maxillary and
mandibular distraction are surgical techniques commonly associated
with orthognathic surgery, which is used to correct both dental and
facial deformities in teenagers and adults. The training necessary to
perform these procedures pertains mainly to the surgical application
of the devices, appropriate selection of the devices, modification of
the osteotomies to produce the desired results, and control and
modification of the vectors of distraction during the distraction
How many of these procedures have you performed?
During the past year, I performed approximately 20 of these
procedures, equally split between the upper and lower jaws. They
usually are appropriate only to one jaw in any given patient....or
Can this be done for over/under bites?
It may be utilized for the correction of midface or upper jaw
deficiency which has resulted in an overbite and in some cases of
underbite, particularly those involving facial asymmetries. The
determination for the appropriateness of distraction vs. more
conventional orthognathic procedures used to correct over/underbites
can best be determined in consultation with the surgeon after
evaluation of and determination of the severity of correction
Distraction osteogenesis in the mandible and maxilla is an
exciting new treatment modality that is an extension of the
techniques developed by Ilizarov 50 years ago for the treatment of
long bone deformities. It has become an accepted treatment in the
orthopedic community for treatment in appropriate cases. During the
1990s, we have seen its development and now utilization in the
correction of both cosmetic and functional dentofacial deformities.
It is a rapidly developing and evolving area in which both new
devices and new techniques are constantly being developed. As it
continues to evolve, it offers hope for treatment of disabled
children and those with deformities so severe that in the past they
As the technology develops, we are finding better, stronger, more
adjustable devices that are allowing more conservative surgeries and
lower rates of complications and morbidities. Distraction
osteogenesis is not intended or meant as a replacement for more
conventional and sometimes conservative techniques for the correction
of dentofacial deformities. It is appropriate for use in younger
populations and those at the more severe end of the scale of
deformity. As with all new techniques, all the answers are not
known...but as the pool of patients who have been treated grows, and
the experience of the providers expands and those providing the
techniques expands, ongoing dialogue will allow better understanding
of the techniques, their goals and their limitations.