Three Surgical Steps to Reconstructing Car Crash Victims' Upper Jaws; Function and Appearance Restored

A surgical process most often
associated with orthopedic surgery has been found effective in the intricate
reconstruction of patients with severe bone loss in the anterior maxilla --
the front portion of the upper jaw. Distraction osteogenesis reconstructs
skeletal deformities through the gradual, controlled displacement of
surgically created fractures to enable simultaneous expansion of soft tissue
and bone volume.


The March 2005 issue of the Journal of Oral and Maxillofacial Surgery
reports on the success of a surgical technique that employs distraction
osteogenesis, bone grafts and dental implants to achieve both functional and
aesthetic results for five patients whose injuries in motor vehicle accidents
left them with such severe bone and soft tissue loss in the front portion of
their upper jaws that traditional surgical procedures were insufficient to
correct their problems. Michael S. Block, DMD, the principal author of the
study ("Reconstruction of severe anterior maxillary defects using distraction
osteogenesis, bone grafts, and implants"), says the technique is promising.
"It can be a viable treatment option for the patient involved in a car
accident, or accidental shooting, or facing jaw tumor removal."


Dr. Block and David G. Baughman, DDS, MD, oral and maxillofacial surgeons
who both practice in New Orleans, La., utilized a treatment plan that combined
bone grafts, tissue expanders and the gradual movement of the underlying bone.


The distraction osteogenesis provided a platform for hard tissue grafting and
even more importantly, for the necessary soft tissue genesis needed to cover
the graft.


The process began with a preoperative workup during which diagnostic casts
were used to create a temporary appliance with teeth, which guided the OMS
during the distraction phase. Prior to and throughout the process, the
patients were educated about the entire treatment plan.


Identical treatment for 5 consecutive patients


According to the Journal study, "After a week for initial healing,
distraction was accomplished with 0.5 mm increments two times each day, until
the desired length of distraction was accomplished." All five patients needed
bone grafts following the distraction process because although adequate tissue
mass was attained, bone mass was inadequate. The grafting occurred between 8
and 14 weeks post-distraction. Four to six months later, seeing that the bone
was restored, the surgeons removed the screws that held the grafts in place
inside of the mouth. With the bone grafting complete, the final phase --
dental implants -- began.


Dental implant restorations proved an excellent way to restore function,
improving aesthetics and easily maintained. The Journal study shows that "In
all 5 patients, dental implants were placed ranging from 4 to 7 per patient,
depending on the span of the defect. A fixed prosthesis was placed in 2
patients with low smile lines and fixed/removable bar clip prostheses were
used in the remaining 3 patients. No implants have been lost with follow-up
ranging from 6 months to 3 years."


Dr. Block said that in addition to motor vehicle accidents causing the
critical trauma these five patients endured, some people might have similar
effects from severe periodontal disease or from shooting accidents.


The Journal of Oral and Maxillofacial Surgery is the peer-reviewed journal
of the American Association of Oral and Maxillofacial Surgeons, the
professional organization representing more than 7,000 oral and maxillofacial
surgeons in the United States. AAOMS supports its members' ability to
practice their specialty through education, research, and advocacy. AAOMS
members comply with rigorous continuing education requirements and submit to
periodic office examinations, ensuring the public that all office procedures
and personnel meet stringent national standards.


American Association of Oral and Maxillofacial Surgeons

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