Innovative Jaw Surgery Gives Children Reason to Smile

Children with facial development problems can benefit from a proven but little-known procedure that "stretches" bone. In distraction osteogenesis surgery, plastic surgeons use devices to help the child's bone grow in the desired shape.

"Small jaws can obstruct breathing," says Dr. Larry Hollier, a specialist in distraction osteogenesis surgery at Texas Children's Hospital. "As a result of facial deformities, children may have problems sleeping, eating or swallowing."

These debilitating symptoms are usually caused by congenital growth problems such as hemifacial microsomia, the second most common facial abnormality after cleft lips and palates.

Previously, patients received bone grafts with mixed results, and often had to wait until adolescence for the procedure, when soft tissue such as nerves, tendons and skin could only be stretched a limited amount to accommodate the bone moved during surgery.

Distraction was first performed in 1951 to lengthen bones in the leg. Dr. Hollier trained under the first surgeon in the United States to perform a facial distraction and has seen many excellent results.

At Texas Children's Plastic Surgery Center, Dr. Hollier and Dr. Terry Taylor, an oral and maxillofacial surgeon, perform thorough patient examinations, which include an analysis of their breathing, bone structure and soft tissues of the face.

Once a child is identified as a suitable candidate for surgery, Dr. Hollier and other distraction team members cut the bone and make a small incision in the skin for pin placement. The distraction rod is connected to the pins on the outside of the child's jaw.

After several days of healing, the device is turned for the first time, and then the child's parent participates in the treatment by turning it one millimeter each day. This draws the fracture apart without disturbing the bone marrow and enables new bone to grow behind it. Pin turning continues for several weeks or until the desired length is achieved.

The appliance remains in place for another six to eight weeks to ensure the new bone is stable. The entire treatment spans approximately three months before the device is removed in the operating room.

"The distraction is essentially painless and leaves only a minor scar," says Dr. Hollier, also assistant professor of surgery at Baylor College of Medicine. "Every child deserves a fair chance at the best life possible, and three months of treatment with the distraction device can last a lifetime."

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©2006 Texas Medical Center

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