Distraction Osteogenesis in the Midface and Maxilla

Lengthening and three-dimensional expansion the maxilla and midface by distraction osteogenesis (DOG) has become an accepted treatment to correct severe maxillary and midface hypoplasia (Wiltfang et al., Br J Oral Maxillofac Surg 40:473–9, 2002). Maxillary and midface distraction osteogenesis is especially indicated in young adults with syndromal and nonsyndromal hypoplastic midfaces. Depending on the initial situation, intraoral and extraoral distraction devices are used. Distraction osteogenesis is also used primarily in patients with cleft lip and palate (CLP). All forms of Le Fort osteotomies, but also lateral segment osteotomies can be combined with DOG. In pronounced syndromal midface hypoplasia, DOG is also used immediately postpartum, especially to treat malignant exorbitism and severe respiratory impairments early enough to obviate the need for a tracheostomy, for example (Cruz et al., J Craniofac Surg 18:355–60, 2007). In this segment of the treatment of syndromic and nonsyndromic maxillary/midface hypoplasia, the DOG has a firm evidence-based position (Marchac and Arnaud, Childs Nerv Syst 15:681–94, 1999; Marchac and Arnaud, J Craniofac Surg 23:235–85, 2012).