RESUMO
PURPOSE: Posterior vault distraction osteogenesis (PVDO) has been utilized during the past 15 years to treat a variety of clinical features commonly presented by patients with Apert syndrome. The objective of this study is to determine the efficacy of PVDO in addressing both elevated intracranial pressure (ICP) and ectopia of the cerebellar tonsils (ECT) in young Apert patients. In addition, we aimed to determine the prevalence of hydrocephalus in Apert syndrome patients who underwent PVDO. METHODS: A retrospective study was made with a cohort of 40 consecutive patients with syndromic craniosynostosis (SC), previously diagnosed with Apert syndrome, who underwent PVDO between 2012 and 2022, and thereafter received at least 1 year of follow-up care. Demographic data and diagnosis, along with surgical and outcome data, were verified using medical records, clinical photographs, radiologic examination, and interviews with the parents of all cohort patients. RESULTS: The average patient age when PVDO was performed was 12.91 ± 10 months. The average posterior advancement distance achieved per patient was 22.68 ± 5.26 mm. The average hospital stay per patient was 3.56 ± 2.44 days. The average absolute and relative blood transfusion volumes were 98.47 ml and 17.63 ml/kg, respectively. Although five patients (14%) presented ECT preoperatively, this condition was completely resolved by PVDO in three of these five patients. One of the three patients whose ECT had completely resolved presented syringomyelia postoperatively, requiring subsequent extra dural foramen magnum decompression. All of the remaining four patients were asymptomatic for ECT for at least 1 year of follow-up, and none of these four patients required any additional treatments to address ECT. Two patients presented hydrocephalus requiring ventriculoperitoneal shunt placement. CONCLUSIONS: This study demonstrates that PVDO both reduces diagnosed elevated ICP symptoms and is partially effective in treating ECT in Apert syndrome patients. Hydrocephalus in Apert syndrome is an uncommon feature. The effectiveness of PVDO in addressing hydrocephalus is uncertain.
Assuntos
Acrocefalossindactilia , Osteogênese por Distração , Complicações Pós-Operatórias , Humanos , Acrocefalossindactilia/cirurgia , Masculino , Feminino , Osteogênese por Distração/métodos , Osteogênese por Distração/efeitos adversos , Estudos Retrospectivos , Lactente , Pré-Escolar , Resultado do Tratamento , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/epidemiologia , Estudos de Coortes , Procedimentos Neurocirúrgicos/efeitos adversos , Procedimentos Neurocirúrgicos/métodos , Criança , Hidrocefalia/cirurgia , Hidrocefalia/etiologiaRESUMO
PURPOSE: The most commonly occurring syndromic craniosynostoses are Apert syndrome, Crouzon syndrome, Pfeiffer syndrome, and Saethre-Chotzen syndrome. There is insufficient data regarding postoperative syndrome-related outcomes following the posterior vault distraction osteogenesis (PVDO) procedure, as well as data addressing whether or not additional procedures will be subsequently necessary to comprehensively treat children who undergo PVDO. Thus, the objective of this study is to describe and compare syndrome-related potential complications and outcomes associated with the PVDO procedure. METHODS: An observational retrospective study was performed on consecutive patients (n=24) with Apert syndrome, Crouzon syndrome, Pfeiffer syndrome, or Saethre-Chotzen syndrome, respectively, who underwent PVDO between 2012 and 2019. Demographic data (patient gender and age when the PVDO procedure was performed), diagnosis, surgery-related data, and outcome data (perioperative and midterm complications and need for additional surgery) were verified. RESULTS: Total relative blood transfusion volumes per kilogram for the patients were as follows: 22.75 ± 9.30 ml for Apert syndrome, 10.73 ± 2.28 ml for Crouzon syndrome (Apert versus Crouzon, p<0.05), 18.53 ± 8.08 ml for Pfeiffer syndrome, and 19.74 ± 9.12 ml for Saethre-Chotzen syndrome. None of the patients required a secondary procedure to alleviate intracranial pressure except for a Saethre-Chotzen patient. CONCLUSION: PVDO is an effective technique to address elevated intracranial pressure in SC patients that alleviates the need for secondary procedures at midterm follow-up. Apert syndrome patients presented relatively higher total blood transfusion rates than Crouzon syndrome patients who were operated on at a later age and weighed more.
Assuntos
Acrocefalossindactilia , Disostose Craniofacial , Craniossinostoses , Osteogênese por Distração , Acrocefalossindactilia/cirurgia , Criança , Disostose Craniofacial/cirurgia , Humanos , Osteogênese por Distração/efeitos adversos , Estudos RetrospectivosRESUMO
BACKGROUND: Surgical treatment of early-onset scoliosis (EOS) with rib-based implants such as the vertical expandable prosthetic titanium rib (VEPTR) is associated with a high rate of complications including surgical site infection, skin breakdown, and implant migration. Many of these complications warrant the need for unplanned reoperations, increasing the burden on an already vulnerable patient population, and introducing the further risk of infection. To provide insight into the risks of early intervention, we investigate the relationship between initial device implantation before the age of 3 and the rate of unplanned reoperation. METHODS: A retrospective review was performed of all patients at a single institution who had undergone VEPTR insertion for EOS with at least a 2-year follow-up from 2007 to 2016. Patients were stratified into the case-cohort (0 to 2 y of age) or the comparison cohort (3 to 10 y of age) based on age at the time of device implantation. Multivariate regression accounting for age and scoliosis etiology was performed to identify factors predictive of unplanned reoperation. RESULTS: A total of 137 of 185 patients treated with VEPTR were identified with 76 (56%) undergoing at least 1 unplanned reoperation during the study time period. There were 68 and 69 patients in the age 0- to 2-year and 3- to 10-year cohorts, respectively. Patients aged 0 to 2 years underwent a higher number of total procedures compared with those aged 3 to 10 (13.1±6.5 vs. 10.6±4.8, P=0.032). A significant difference was found in the rate of unplanned reoperation between the 2 cohorts with 44 (65%) patients aged 0 to 2 and 32 (46%) patients aged 3 to 10 undergoing at least 1 unplanned reoperation (P=0.031). Binary logistic multivariate regression accounting for age and scoliosis etiology demonstrated that patients aged 0 to 2 had a significantly greater odds of undergoing an unplanned reoperation (odds ratio=3.050; 95% confidence interval: 1.285-7.241; P=0.011) compared with patients aged 3 to 10 years. CONCLUSION: Overall, EOS patients aged 0 to 2 at initial VEPTR implantation are up to 3 times higher risk of undergoing an unplanned reoperation compared with those aged 3 to 10. LEVEL OF EVIDENCE: Level III.
Assuntos
Osteogênese por Distração/efeitos adversos , Complicações Pós-Operatórias/etiologia , Reoperação/estatística & dados numéricos , Costelas/cirurgia , Escoliose/cirurgia , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Osteogênese por Distração/instrumentação , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Escoliose/congênito , Infecção da Ferida Cirúrgica , TitânioRESUMO
BACKGROUND: Implantable rib-based distraction devices have revolutionized the treatment of children with early onset scoliosis and thoracic insufficiency syndrome. Unfortunately, the need for multiple skin incisions and repeated surgeries in a fragile patient population creates considerable infection risk. In order to assess rates of infection for different incision locations and potential risk factors, we generated a prospectively collected database of patients treated with rib-based distraction devices. METHODS: We analyzed a cohort of patients with thoracic insufficiency syndrome from various etiologies that our institution treated with rib-based distraction devices from 2013 to 2016. Surgery type (implantation, expansion, revision/removal), and surgeon adjudicated surgical site infection (SSI) were collected. For this study, we developed a novel, rib-based distraction device surgical site labeling system in which incisions could be labeled as either proximal or distal surgical exposure areas. Treating surgeons documented the operative site, procedure, and SSI site in real-time. RESULTS: A total of 166 unique patients underwent 670 procedures during the study period, producing 1537 evaluable surgical sites; 1299 proximal and 238 distal. Patients were 6.81±4.0 years of age on average. Forty-seven procedures documented SSIs (7.0%), while 40 (24.1%) patients experienced an infection. Analysis showed significant variation in the rate of infection between implantation, and expansion, and revision procedures, with implantation procedures having the highest infection rate at 13.1% (P<0.01). Infections occurred more frequently at distal sites than proximal ones (P=0.02). CONCLUSIONS: Our novel, surgeon-entered, prospective quality improvement database has identified distal surgical sites as being at higher risk for SSI than proximal ones. Further, rib-based distraction device implantation procedures were identified as being at a greater risk for SSI than expansion or revision procedures. We believe this data can lead to improved prevention measures, anticipatory guidance, and patient care. LEVEL OF EVIDENCE: Level II-prognostic study.
Assuntos
Osteogênese por Distração/efeitos adversos , Costelas/cirurgia , Escoliose/cirurgia , Infecção da Ferida Cirúrgica/epidemiologia , Criança , Pré-Escolar , Estudos de Coortes , Bases de Dados Factuais , Humanos , Philadelphia/epidemiologia , Próteses e Implantes/efeitos adversos , Melhoria de Qualidade , Reoperação , Estudos Retrospectivos , Fatores de Risco , Infecção da Ferida Cirúrgica/etiologia , Doenças Torácicas/cirurgiaRESUMO
PURPOSE: The purpose of this study was to evaluate the indications, safety, and short-term outcomes of posterior vault distraction osteogenesis (PVDO) in patients with no identified acrocephalosyndactyly syndrome (study) and to compare those to a syndromic cohort (controls). METHODS: Demographic and perioperative data were recorded and compared across the study and control groups for those who underwent PVDO between January 2009 and December 2016. Univariate analysis was conducted using χ and Fisher exact tests for categorical variables, and Mann-Whitney U test for continuous variables. RESULTS: Sixty-three subjects were included: 19 in the nonsyndromic cohort, 44 in the syndromic cohort. The cohorts had similar proportion of subjects exhibiting pansynostosis (42.1% of nonsyndromic versus 36.4% of syndromic, Pâ=â0.667). The nonsyndromic cohort was significantly older (4.04â±â3.66 years versus 2.55â±â3.34 years, Pâ=â0.046) and had higher rate of signs of raised intracranial pressure (68.4% versus 25.0%, Pâ=â0.001) than the syndromic cohort. There was no significant difference in perioperative variables or rate of complications (Pâ>â0.05). The mean total advancement distance achieved was similar, 27â±â6âmm in the nonsyndromic versus 28â±â8âmm in the syndromic cohort (Pâ=â0.964). All nonsyndromic subjects with signs of raised intracranial pressure demonstrated improvement at an average follow-up of 22 months. CONCLUSION: As in the syndromic patient, PVDO is a safe and, in the short-term, effective modality for cranial vault expansion in the nonsyndromic patient. The benefits and favorable perioperative profile of PVDO may therefore be extended to patient populations other than those with syndromic craniosynostosis.
Assuntos
Craniossinostoses/complicações , Craniossinostoses/cirurgia , Hipertensão Intracraniana/etiologia , Osteogênese por Distração/métodos , Acrocefalossindactilia/complicações , Acrocefalossindactilia/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Osteogênese por Distração/efeitos adversos , Crânio/cirurgia , SíndromeRESUMO
BACKGROUND: Convex hemiepiphysiodesis has been reported to have mixed results in the treatment of congenital spine deformities. Multiple modifications of the original technique were suggested to improve the results. The purpose of this study is to report the results and complications of an instrumented convex growth arrest procedure modified with concave distraction. METHODS: The records of 11 patients with long sweeping congenital curves (involving multiple anomalous vertebrae) who underwent convex instrumented hemiepiphysiodesis with concave distraction were evaluated. Mean age at index operation was 58 months (range, 29 to 101 mo). Lengthening of the concave distraction rod was done every 6 months. The magnitude of coronal/sagittal deformity and T1-T12 height were measured on the preoperative, postoperative, and latest follow-up radiographs. Average follow-up was 44.9 months (range, 24 to 89 mo). RESULTS: In the coronal plane, the convex hemiepiphysiodesis segment was corrected from an average of 60.5 to 40.4 degrees postoperatively and further improved to 35.5 degrees at the latest follow-up. The distracted segment was corrected from 33.4 to 15.2 degrees postoperatively and to 12.7 degrees at the latest follow-up. Sagittal plane alignment was minimally affected. The average T1-T12 height was 157.1 mm in the early postoperative period and 181.1 mm at last follow-up. During follow-up, we identified partial pull-out of screws on the distraction side in 5 of the 11 patients and rod breakages in 3 patients. These were revised during planned lengthenings. There were no unplanned surgeries, deep wound infections, nor neurological complications. CONCLUSIONS: Convex instrumented hemiepiphysiodesis with concave distraction resulted in good curve correction while maintaining the growth of thorax. The correction of the anomalous segment improved over time, proving the effectiveness of the hemiepiphysiodesis. Addition of a concave distraction construct appears to enhance spinal growth, thereby augmenting the hemiepiphysiodesis effect.
Assuntos
Osteogênese por Distração/métodos , Escoliose/cirurgia , Fusão Vertebral/métodos , Vértebras Torácicas/cirurgia , Criança , Pré-Escolar , Falha de Equipamento , Feminino , Seguimentos , Humanos , Fixadores Internos/efeitos adversos , Masculino , Osteogênese por Distração/efeitos adversos , Reoperação , Estudos Retrospectivos , Escoliose/diagnóstico por imagem , Fusão Vertebral/efeitos adversos , Fusão Vertebral/instrumentação , Vértebras Torácicas/diagnóstico por imagem , Resultado do TratamentoRESUMO
The aims of this study were to document the incidence of new-onset craniosynostosis (NOC) after posterior vault distraction osteogenesis (PVDO), to determine risk factors for the development of NOC, and to deduce the cranial ramifications of NOC. An institutional review board-approved retrospective review of all patients who underwent PVDO at the Children's Hospital of Philadelphia was performed. Demographics, perioperative data, as well as preoperative and postoperative three-dimensional computed tomographic scans were analyzed. Suture patency preoperatively and postoperatively was recorded.Thirty patients underwent PVDO for suspected increased intracranial pressure and/or severe turribrachicephaly from 2008 to 2013. Twenty-four patients had syndromic diagnoses. The average age at the time of PVDO was 2.03 years. Distraction distances ranged from 19 to 40 mm, with an average of 28.7 mm. Among the 19 patients who had patent lambdoid sutures before PVDO, new-onset lambdoid fusion was seen in 17 patients after PVDO (89.5%), whereas the suture remained open in 2 patients (10.5%). New-onset lambdoid fusion was not significantly associated with age at distraction (P = 0.28), sex (P = 0.47), length of distraction (P = 0.93), or diagnosis (P = 0.61). Similarly, new-onset sagittal synostosis was not associated with age at distraction (P = 0.06), sex (P = 0.64), length of distraction (P = 0.83), or diagnosis (P = 0.25). None of the patients who developed NOC had characteristic head shape changes such as mastoid bulges or scaphocephaly. New-onset lambdoid and sagittal synostoses occur frequently after PVDO. Although the diagnosis of NOC is obvious radiographically, the clinical importance of the diagnosis morphometrically, neurodevelopmentally, and in cranial growth has yet to be fully investigated.
Assuntos
Craniossinostoses/etiologia , Osteogênese por Distração/efeitos adversos , Adolescente , Criança , Pré-Escolar , Craniossinostoses/epidemiologia , Craniossinostoses/cirurgia , Feminino , Humanos , Incidência , Lactente , Hipertensão Intracraniana/cirurgia , Masculino , Osteogênese por Distração/métodos , Philadelphia/epidemiologia , Estudos Retrospectivos , Fatores de RiscoRESUMO
Introdução: O desenvolvimento das técnicas de distracção do esqueleto craniofacial representou um grande avanço na prática da cirurgia craniofacial. A distracção é uma técnica menos invasiva, mais rápida e com uma morbidade aparentemente menor comparada com as técnicas tradicionais de reconstrução craniofacial. No ano de 2013, o serviço de Cirurgia Crânio Maxilo Facial do INTO realizou uma série de casos de distracção mandibular. Este trabalho objetiva apresentar nossa experiência. Métodos: De janeiro a março de 2013, sete pacientes realizaram cirurgia de distracção mandibular. Todos os pacientes operados apresentavam hipoplasia mandibular uni ou bilateral em decorrência de anquilose de ATM ou microssomia craniofacial. Em alguns pacientes com anquilose de ATM foi realizada também a ressecção do bloco anquilótico no mesmo tempo da distracção. Resultados: No pós-operatório houve melhora de todas as funções estomatognáticas, ganho de peso, decanulação da paciente traqueostomizada e melhora na qualidade do sono. Houve melhora nos perfis faciais, as laterognatias foram amenizadas e a abertura oral aumentou na maioria dos pacientes. A abertura oral aumentou de maneira mais significativa naqueles pacientes onde a cirurgia de anquilose foi realizada em conjunto com a distracção. A complicação mais comum foi dor à ativação, relato de cinco pacientes (71%).Conclusão: A distracção osteogênica da mandíbula é uma boa alternativa para o tratamento das hipoplasias mandibulares, muitas vezes sendo a primeira indicação em algumas situações clínicas. Aparentemente tem morbidade menor do que as reconstruções clássicas de mandíbula e possui o bônus de alongar também os tecidos moles.
Introduction: The introduction of distraction of the craniofacial skeleton represented a great advancement in the practice of craniofacial surgery. Distraction is a less invasive technique that is faster and with an apparently lower morbidity than the traditional craniofacial reconstruction techniques. In 2013, the craniomaxillofacial surgery service of the Institute of Traumatology and Orthopaedics performed a series of mandibular distraction surgeries. In this article, we aim to present our experience. Methods: From January to March 2013, seven patients underwent mandibular distraction surgery. All patients exhibited unilateral or bilateral mandibular hypoplasia due to ankylosis of the temporomandibular joint (TMJ), or craniofacial microsomia. In some patients with ankylosis of the TMJ, resection of the anlylotic block was also performed concomitantly with the distraction. Results: Postoperative improvement was noted in all the stomatognathic functions: weight gain, decannulation of a tracheostomized patient, and improved quality of sleep. There was an improvement in facial profiles: the laterognathism was eased and the mouth opening increased in most patients. The mouth opening increased more significantly in patients in whom ankylosis surgery was done in conjunction with the distraction. The most common complication was pain upon distraction, reported by five patients (71%). Conclusion: Mandibular distraction osteogenesis is a good alternative for the treatment of mandibular hypoplasia, often being the first indication in some clinical situations. It apparently has a lower morbidity than the classic mandible reconstructions and has the added benefit of also lengthening the soft tissues.
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Relatos de Casos , Estudos Retrospectivos , Anormalidades Craniofaciais , Osteogênese por Distração , Procedimentos de Cirurgia Plástica , Face , Ossos Faciais , Mandíbula , Anquilose , Desenvolvimento Maxilofacial , Anormalidades Craniofaciais/cirurgia , Osteogênese por Distração/efeitos adversos , Osteogênese por Distração/métodos , Procedimentos de Cirurgia Plástica/métodos , Face/cirurgia , Ossos Faciais/cirurgia , Mandíbula/cirurgia , Mandíbula/patologia , Anquilose/cirurgia , Anquilose/patologiaRESUMO
INTRODUÇÃO: Considerando-se que as craniossinostoses são afecções basicamente suturais, o fato de o cérebro estar aprisionado em um compartimento fechado, que não possui a complacência necessária para acompanhar seu crescimento, se constitui no desafio principal de seu tratamento. O objetivo do tratamento é restabelecer a complacência da sutura estenótica e corrigir a deformidade craniana compensatória. Este trabalho propõe a associação de osteotomia helicoide à distração osteogênica proporcionada pelo uso das molas distratoras para remodelar defeitos craniofaciais causados por craniossinostoses. MÉTODO: Entre julho de 2010 e julho de 2012, foram tratados 10 pacientes portadores de craniossinostoses, sendo 5 oxicefalias, 3 escafocefalias, 1 turricefalia e 1 trigonocefalia. O tratamento consistiu na aplicação de molas de Lauritzen, para corrigir a deformidade primária da craniossinostose, com a associação de craniotomia helicoide em forma de Nautilus nos sítios de deformação secundária do crânio, sem descolamento dural. RESULTADOS: Foi observada resolução da deformidade craniana e remissão dos sinais clínicos de hipertensão intracraniana. Nenhum paciente apresentou complicações, como fístula liquórica, infecção local, seroma ou hematoma. CONCLUSÕES: A associação da osteotomia helicoide com a distração ou contração promovida pelas molas permitiu remodelar ativamente o crânio, facilitando a acomodação do conteúdo cerebral no continente craniano.
INTRODUCTION: Considering that craniosynostosis is a suture-related condition, the main challenge for its treatment is the fact that the brain is located in a closed compartment that does not have the required adaptability to accommodate its growth. The goal of treatment is to restore stenotic suture adaptability and correct the compensatory cranial deformity. This paper proposes the combined use of spiral osteotomy with distraction osteogenesis by the use of distracting springs to remodel craniofacial defects caused by craniosynostosis. METHODS: Between July 2010 and July 2012, 10 patients with craniosynostosis were treated: 5 with oxycephaly, 3 with scaphocephaly, 1 with turricephaly, and 1 with trigonocephaly. The treatment consisted of the application of Lauritzen springs to correct the primary craniosynostosis defect in combination with a nautilus-shaped spiral craniotomy at the secondary deformation sites without dural detachment. RESULTS: Resolution of cranial deformity and remission of the clinical signs of intracranial hypertension were observed. None of the patients had complications such as cerebrospinal fluid fistula, local infection, seroma, or hematoma. CONCLUSIONS: The combined use of spiral osteotomy with spring-mediated distraction or contraction enables active reshaping of the skull and facilitates accommodation of the brain by the cranial cavity.
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , História do Século XXI , Osteotomia , Crânio , Anormalidades Craniofaciais , Hipertensão Intracraniana , Osteogênese por Distração , Procedimentos de Cirurgia Plástica , Craniossinostoses , Craniotomia , Nautilus , Osteotomia/métodos , Crânio/cirurgia , Anormalidades Craniofaciais/cirurgia , Hipertensão Intracraniana/cirurgia , Hipertensão Intracraniana/patologia , Osteogênese por Distração/efeitos adversos , Osteogênese por Distração/métodos , Procedimentos de Cirurgia Plástica/métodos , Craniossinostoses/cirurgia , Craniotomia/métodos , Nautilus/anatomia & histologia , Nautilus/crescimento & desenvolvimentoRESUMO
Surgically assisted rapid maxillary expansion (SARME) is an effective and stable method for treating severe maxillary transverse discrepancies in skeletally mature individuals, but it has potential complications. The authors report the case of a 34-year-old woman who developed carotid cavernous fistula after undergoing SARME with a bone anchored appliance and discuss the possible etiological basis of this condition.
Assuntos
Fístula Carótido-Cavernosa/etiologia , Procedimentos de Ancoragem Ortodôntica/efeitos adversos , Técnica de Expansão Palatina/efeitos adversos , Adulto , Fístula Carótido-Cavernosa/diagnóstico , Fístula Carótido-Cavernosa/cirurgia , Embolização Terapêutica , Feminino , Humanos , Angiografia por Ressonância Magnética , Maxila/cirurgia , Osteogênese por Distração/efeitos adversos , Osteogênese por Distração/instrumentaçãoRESUMO
PURPOSE: Legg-Calvé-Perthes (LCP) disease is currently managed by mechanical containment of the femoral head in the hip socket. As evidence suggests that hip distraction may offer a new treatment strategy, we used arthrodistraction as a primary treatment for active forms of LCP disease and prospectively compared the results with the Salter innominate osteotomy. METHODS: A total of 54 children, six years or older of both genders with severe forms of LCP disease in the stages of necrosis or revascularisation, were enrolled. Patients were submitted to either Salter innominate osteotomy (n = 28) or hip arthrodistraction (n = 26). Final radiographs were used to evaluate the Mose index, Wiberg angle, extrusion index and the Stulberg et al. classification. RESULTS: There were no significant differences in gender, age, lateral pillar classification and average follow-up time between the two groups. The osteotomy group progressed without major complications, but children in the joint distraction group experienced episodes of pin tract pain and infection, leading to the early removal of the external device in one case. Two patients developed joint stiffness, treated by physiotherapy or manipulation, and one child developed subluxation of the femoral head. The average time in distraction was 4.44 months (2.53-7.23 months). In the final evaluation the osteotomy group showed better containment of the femoral head. The Mose index and the Stulberg et al. classification were statistically similar between the two groups. CONCLUSIONS: Despite similar final radiological results, arthrodistraction was associated with a higher morbidity. Consequently, we do not recommend hip distraction as a primary treatment for the early stages of LCP disease.
Assuntos
Cabeça do Fêmur/cirurgia , Articulação do Quadril/cirurgia , Doença de Legg-Calve-Perthes/cirurgia , Osteogênese por Distração/métodos , Osteotomia/métodos , Criança , Pré-Escolar , Feminino , Cabeça do Fêmur/diagnóstico por imagem , Cabeça do Fêmur/patologia , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/patologia , Hospitais Universitários , Humanos , Doença de Legg-Calve-Perthes/diagnóstico , Doença de Legg-Calve-Perthes/diagnóstico por imagem , Masculino , Osteogênese por Distração/efeitos adversos , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Radiografia , Centros de Atenção Terciária , Atenção Terciária à SaúdeAssuntos
Humanos , Cirurgia Bucal , Educação em Odontologia , Osteogênese por Distração/educação , Osteogênese por Distração/efeitos adversos , Procedimentos Cirúrgicos Bucais , Procedimentos de Cirurgia Plástica/métodos , Anestesia Dentária , Anormalidades Maxilomandibulares/cirurgia , Doenças Maxilomandibulares/cirurgia , Implantação Dentária , Implantes Dentários , Mandíbula/cirurgia , Ossos Faciais/cirurgiaRESUMO
We undertook a retrospective study of 50 consecutive patients (41 male, 9 female) with an infected nonunion and bone defect of the femoral shaft who had been treated by radical debridement and distraction osteogenesis. Their mean age was 29.9 years (9 to 58) and they had a mean of 3.8 (2 to 19) previous operations. They were followed for a mean of 5.9 years (2.0 to 19.0). The mean duration of the distraction osteogenesis was 24.5 months (2 to 39). Pin-track infection was observed in all patients. The range of knee movement was reduced and there was a mean residual leg-length discrepancy of 1.9 cm (0 to 8) after treatment. One patient required hip disarticulation to manage intractable sepsis. In all, 13 patients had persistent pain. Bony union was achieved in 49 patients at a mean of 20.7 months (12 to 35). Although distraction osteogenesis is commonly used for the treatment of infected femoral nonunion with bone defects, it is associated with a high rate of complications.
Assuntos
Fraturas do Fêmur/cirurgia , Fraturas não Consolidadas/cirurgia , Osteogênese por Distração/efeitos adversos , Infecção da Ferida Cirúrgica/cirurgia , Adolescente , Adulto , Criança , Desbridamento/efeitos adversos , Desbridamento/métodos , Feminino , Humanos , Técnica de Ilizarov , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Osteogênese por Distração/métodos , Osteomielite/cirurgia , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
The monobloc frontofacial osteotomy provides aesthetic and functional improvement in the treatment of various craniofacial deformities. This procedure, through highly complex, has had some significant associated complication, such as cerebrospinal fluid leakage, hematoma, infection, and bone resorption. Distraction has been successfully used to gradually elongate bone and soft tissue. This method seems to provide improved results over conventional surgery, with less morbidity. We present a case of a patient with Apert syndrome who underwent monobloc advancement using the Rigid External Device (RED) device and who developed a transient bilateral amaurosis on the fourth postoperative day before distraction. A second procedure was performed to push back the frontal bandeau, maintaining the device in position. The blindness was resolved with this procedure as well as treatment with systemic steroids. The distraction was started thereafter, and the desired improvement was acquired. To our knowledge, this is the first case of transient bilateral amaurosis in a patient undergoing monobloc distraction.
Assuntos
Acrocefalossindactilia/terapia , Cegueira/etiologia , Ossos Faciais/cirurgia , Osso Frontal/cirurgia , Osteogênese por Distração/efeitos adversos , Complicações Pós-Operatórias/etiologia , Cegueira/terapia , Criança , Ossos Faciais/anormalidades , Feminino , Osso Frontal/anormalidades , Glucocorticoides/uso terapêutico , Humanos , Metilprednisolona/uso terapêutico , Osteogênese por Distração/métodos , Complicações Pós-Operatórias/terapia , Procedimentos de Cirurgia Plástica/efeitos adversos , Procedimentos de Cirurgia Plástica/métodosRESUMO
BACKGROUND: Mandibular distraction is an effective treatment for mandibular hypoplasia. Special care must be done while performing the corticotomies to prevent injuries to blood vessels or nerves nearby. A rare iatrogenic severe injury occurred while performing this operation. REPORT OF PATIENT: A 3 year-old girl was operated upon to correct mandibular hypoplasia. A rotating saw was used to perform corticotomies in the mandibular angle. In the right side occurred acute bleeding and in the saw there was a piece of a blood vessel that was 15 mm long and 2 mm in diameter with an open lumen. Exploration of the neck revealed that the most distal segment of the internal carotid artery was severed, with a thrombus in the proximal end. The distal segment retracted into the temporal bone without bleeding. The proximal artery was ligated. After recovery she moved well. A computed tomogram was normal and further condition improved clinically. CONCLUSION: This complication from the use of a rotary saw has not been documented previously and it must be prevented by using some protection behind the bone.
Assuntos
Lesões das Artérias Carótidas/etiologia , Doença Iatrogênica , Mandíbula/cirurgia , Avanço Mandibular/efeitos adversos , Osteogênese por Distração/efeitos adversos , Trombose das Artérias Carótidas/etiologia , Artéria Carótida Interna , Pré-Escolar , Feminino , Humanos , Avanço Mandibular/instrumentação , Micrognatismo/cirurgiaRESUMO
BACKGROUND: The present study evaluates implant survival and peri-implant bone loss around posterior mandible dental implants placed at sites of distraction osteogenesis. METHODS: On removal of the distraction devices, 34 dental implants were inserted into 14 posterior mandible sites in 10 healthy, non-smoking female patients. Prosthetic treatment was performed 4 months after implant placement using fixed implant prostheses. After 6 to 16.5 months, periapical radiographs were taken and evaluated for peri-implant bone loss and radiolucency. The distance between the implant margin and the first visible bone-implant contact was measured on the mesial and distal aspects of the implants using imaging software. Radiographic dimensional distortion was corrected as a function of the known true dimension of the implant. RESULTS: Of the 34 implants placed, two (5.9%) failed to integrate at reentry surgery. Both were replaced and restored during the course of the study so that a total of 34 implants was followed for 12.1 +/- 3.8 months post-restoration and 16.1 +/- 3.8 months post-insertion. Mean loss of marginal bone height was 2.6 +/- 1.0 mm. During the follow-up period, radiolucent lines along the implant surface were absent. CONCLUSIONS: The mean peri-implant bone loss in areas of alveolar bone distraction was 1.9 mm/year. A high implant survival rate was observed.
Assuntos
Perda do Osso Alveolar/etiologia , Aumento do Rebordo Alveolar/efeitos adversos , Implantação Dentária Endóssea/efeitos adversos , Implantes Dentários/efeitos adversos , Osteogênese por Distração/efeitos adversos , Adulto , Perda do Osso Alveolar/diagnóstico por imagem , Aumento do Rebordo Alveolar/métodos , Dente Pré-Molar , Prótese Dentária Fixada por Implante , Falha de Restauração Dentária , Feminino , Humanos , Arcada Parcialmente Edêntula/reabilitação , Modelos Lineares , Mandíbula/cirurgia , Pessoa de Meia-Idade , Dente Molar , RadiografiaRESUMO
The aim of this retrospective study was to analyse the outcome of alveolar distraction osteogenesis for the correction of vertical defects in a large series of 55 cases. The existing bone deficiencies were secondary to atrophy after periodontal disease or tooth extraction. The overall success rate of this technique was 89.1%. The complications presented during treatment were divided into minor (no effect on final result, but immediate intervention required) 14/55 patients (25.4%), and major (lead to technique failure) 6/55 patients (10.9%). The frequency of minor complications was 8/27 in the anterior maxillary region, 1/27 in the anterior mandibular region and 15/27 in the posterior mandibular region. The frequency of major complications was 5/6 in the posterior mandibular region and 1/6 in the anterior maxillary region. The mean alveolar height achieved was 6mm. The overall rate was 36.3%. On the basis of these results it was concluded that alveolar distraction osteogenesis is an effective technique to treat vertical alveolar ridge deficiencies.
Assuntos
Aumento do Rebordo Alveolar/métodos , Maxila/cirurgia , Osteogênese por Distração/efeitos adversos , Adulto , Perda do Osso Alveolar/cirurgia , Aumento do Rebordo Alveolar/efeitos adversos , Implantação Dentária Endóssea , Feminino , Humanos , Masculino , Complicações Pós-Operatórias , Estudos Retrospectivos , Resultado do Tratamento , Dimensão VerticalRESUMO
O propósito de nosso trabalho foi avaliar, por meio de uma análise retrospectiva, as complicações que ocorrem na técnica de Distração Osteogênica Alveolar. Para isso foram avaliados 72 pacientes que possuem defeitos verticais do rebordo alveolar e que foram tratados pela técnica de distração osteogênica, utilizando-se para isso distratores extra-alveolares Distractor® (Conexão, sistema de Próteses, SP - Brasil). O acompanhamento foi feito para determinar se houve complicação ou não, tendo como resultado 31 pacientes com complicações maiores ou menores (43,05%) e 41 sem complicações (56,95%). A maior parte das complicações foram classificadas como menores e que podem ser solucionadas por meio de uma pronta intervenção por parte do profissional, o que não interfere no sucesso da técnica
Assuntos
Humanos , Masculino , Feminino , Implantes Dentários , Osteogênese por Distração , Osteogênese por Distração/efeitos adversosRESUMO
El proceso de generación de nuevo hueso por estiramiento del callo óseo se denomina osteogénesis por distracción. Este proceso se aplica también a los huesos del macizo craneofacial, y en especial a la mandíbula, para tratar defectos mandibulares que aparecen en diferentes síndromes, como el Treacher Collins, microsomía hemifacial, Pierre Robins, apnea obstructiva del sueño y otras deformidades secundarias a anquilosis de la articulación temporomandibular y traumas. Se realizó una revisión bibliográfica del tema. Nuestro estudio de 45 series publicadas arrojó que el tipo de distractor más usado es el extraoral, que el hueso más tratado es la mandíbula, que solo el 4,4(por ciento) de los autores realizan estudios cefalométricos para la evaluación de los resultados y que las complicaciones más frecuentes son la avulsión parcial de los pines, dolor en la ATM y limitación de la apertura bucal(AU)
The process of generation of a new bone by lengthening the osteal callus is called osteogenesis by distraction. This process is also applied to bones of the craniofacial skeleton and, specially, to the mandible to treat mandibular defects appearing in different syndromes, such as Treacher Collins, hemifacial microsomy, Pierre Robins, obstructive sleeping apnea, and other deformities secondary to ankylosis of the temporomandibular joint and traumas. A bibliographic review of the topic was made. Our study of 45 series published showed that the extraoral was the most used type of distractor, that the mandible was the most treated bone, that only 4.4 % of the authors conduct cephalometric studies to evaluate the results, and that partial avulsion of the pins, pain in the TMA and limitation to open the mouth were the most frequent complications(AU)
Assuntos
Humanos , Articulação Temporomandibular/anormalidades , Osteogênese por Distração/efeitos adversos , Osteogênese por Distração/métodos , Literatura de Revisão como Assunto , Avaliação de Resultados em Cuidados de Saúde/métodosRESUMO
This investigation aimed to compare and contrast practical difficulties experienced by 54 children from three different centres (Mexico City, New York, Paris) treated with either extra-oral or intra-oral distraction devices. The possible effect of distraction osteogenesis on pain/sleeping difficulty, speech and eating problems and disturbance of recreational activities and alteration in sensation were investigated. It was expected that intra-oral devices would reduce the difficulties associated with the distraction process and their psychological effect on the child. Some benefits resulting from the use of intra-oral devices were identified, these included fewer sleeping problems (P = 0.006) and less disturbance of recreational activities (P = 0.002). However, eating and maintaining oral hygiene were more problematic with intra-oral devices the differences between the intra-oral and extra-oral groups was approaching significance at P = 0.07. A major disadvantage of the extra oral device was scarring. In both groups the alteration of lip sensation was temporary, pain was limited to the time of activation of the distraction device. A high level of patients' cooperation was mandatory for successful completion of the treatment.