title: Transsutural distraction osteogenesis applied to maxillary complex with new internalized distraction device: analysis of the feasibility and long-term osteogenesis outcome.
abstract: BACKGROUND
  The purposes of this study were to evaluate the effects of transsutural distraction osteogenesis applied to the maxillary complex with a new internalized distraction device and to analyze the long-term osteogenesis outcome.
  
  
  METHODS
  Three-month-old beagle dogs were treated with a self-designed internalized distractor. The feasibility was evaluated, and the effects of the maxillary growth were measured using radiography and computed tomography (CT). The regenerated bone was examined with micro-CT, biomechanical testing, and histology 1 year after the distraction.
  
  
  RESULTS
  The experimental group showed significantly larger forward displacement of maxillary during the distraction. One year after the distraction, the micro-CT showed more incompact structure and bone volume/total volume was significantly less in the experimental group. Biomechanical testing also showed a significantly lower yield but with no difference in stiffness. Histologic staining found osteoclasts deposited in the region of the suture and osteoblasts on the bone surface. The immunohistochemical staining of osteoprotegrin and receptor activator of nuclear factor-κ B ligand showed evidence of expression in suture area components and osteocytes with no difference between the groups.
  
  
  CONCLUSIONS
  Transsutural distraction osteogenesis using an internalized distractor with skull anchorage demonstrated feasibility. It is expected that this device may provide new thoughts in developing an appropriate appliance for clinical use in young patients with midfacial hypoplasia. Moreover, the long-term osteogenesis analysis findings suggest that the metabolism of sutural area still remained active, which enhanced our understanding of bone remodeling in the sutural area to manage maxillary relapse after transsutural distraction osteogenesis.
authors: From the *Department of Cleft Lip and Palate, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing; †Department of Aesthetic, Plastic and Burn Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong; and ‡Department of Burns and Plastic Surgery, First Affiliated Hospital of Xiamen University, Xiamen, China.
authors: Haizhou
authors: H
authors: Tong
authors: Feng
authors: F
authors: Gao
authors: Jiapeng
authors: J
authors: Yin
authors: Xiangyu
authors: X
authors: Zhang
authors: Chen
authors: C
authors: Zhang
authors: Ningbei
authors: N
authors: Yin
authors: Zhenmin
authors: Z
authors: Zhao
mesh_terms: D000818:Animals; D001696:Biomechanical Phenomena; D001861:Bone Regeneration / Q000502:physiology; D016723:Bone Remodeling / Q000502:physiology; D003393:Cranial Sutures / Q000254:growth & development / Q000473:pathology / Q000601:surgery*; D004285:Dogs; D055119:Elastic Modulus; D005240:Feasibility Studies; D016268:Internal Fixators; D008297:Male; D008437:Maxilla / Q000254:growth & development / Q000473:pathology / Q000601:surgery*; D023421:Models, Animal; D010006:Osteoblasts / Q000473:pathology; D010010:Osteoclasts / Q000473:pathology; D010011:Osteocytes / Q000473:pathology; D010012:Osteogenesis / Q000502:physiology; D019857:Osteogenesis, Distraction / Q000295:instrumentation* / Q000379:methods; D053244:Osteoprotegerin / Q000032:analysis; D053245:RANK Ligand / Q000032:analysis; D011897:Random Allocation; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D055114:X-Ray Microtomography / Q000379:methods
chemical_list: D053244:Osteoprotegerin; D053245:RANK Ligand