Physicians at the Rush Craniofacial Center in Chicago have adapted an orthopedic surgical technique previously used to lengthen bones in the leg into a pioneering treatment for craniofacial patients that dramatically improves hearing, vision, chewing problems, appearance, and limits the need for repeated, complicated surgeries.
Co-directors of the Rush Craniofacial Center Dr. John W. Polley, chairman of plastic and reconstructive surgery, and Dr. Alvaro A. Figueroa, a dentist with extensive training in craniofacial anomalies and orthodontics, have pioneered a bone-lengthening treatment, known as distraction osteogenesis, for patients with congenital facial disorders. "It's a nice marriage of art and dentistry and the art of craniofacial surgery. When we've put the two together we've come up with some pretty unique concepts."
One of these concepts is a new treatment for the full range of anomalies that affects the middle of the face, including the ears, the eyes, the lip and the palate. Representative of many of these conditions is Crouzon syndrome, a congenital disorder in which the bones of the face and skull fuse too soon, causing a shortage of facial bone. The disorder results in a face sunken in appearance and eyes that protrude. Previous treatments for the included multiple surgeries in which bones taken from the hips or ribs were used to reshape the face.
By adapting the bone-lengthening techniques of orthopedic surgery for use on the face, Polley and Figueroa have been able to reduce the need for repeated and painful procedures.
Following a surgery in which Polley makes cuts in the facial bones that need lengthening, a specifically designed cranial halo--device is connected to the skull and teeth by screws and wires. Tiny daily adjustments to the screws over the course of several weeks pull the face and jaw forward a fraction of an inch at a time.
"The body reacts as it would with any fracture--it begins to heal the cuts by laying down new bone," Polley explains. "So as the device gradually pulls the face forward, the surgical cuts fill in with the new bone and the facial bones are steadily elongated. Over six weeks, facial bones can be lengthened by as much as 25 millimeters, about the length of a paper clip. This greatly improves the facial symmetry and appearance. It also widen the bones forming the nasal passage and jaw, correcting breathing and the bite."
Patients who have worn the halo-device reported feeling no pain when the screws and wires were tightened, and compared the procedure to the way braces tighten teeth. Aside from weekly check-ups at Rush, the patients make daily adjustments to the halo device at home. Patients have reported seeing physical improvements in just two weeks.
Dr. Polley reports that distraction osteogenesis is now a standard treatment for severe craniofacial deformities and used at medical centers around the world. For most patients, it provides a simpler, more effective alternative to repeated, painful bone grafts major surgeries in which deformities are corrected using bones from other parts of the body. "Distraction is less invasive, and the results are more stable and longer-lasting. It allows the body to fix the deformity by generating new bone precisely where it is needed."
Under the direction of Polley and Figueroa, the center offers a comprehensive approach for children and adults with all forms of facial deformities. Professionals from fields such as neurosurgery, pediatrics, pediatric otolaryngology, speech and language pathology, nursing, dentistry, social work and genetics work together to meet the unique needs of each patient and family.
There are over 70,000 American born in the last decade with craniofacial abnormalities severe enough to require surgery.
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