1. Distraction osteogenesis RED (Rigid External Distraction) of Mid-Facial Deficiency
Dr. Aghyad al Mobayed
Consultant Oral& Maxillofacial surgeon
Al Shifa Hospital - Gaza ,Palestine

3. Distraction osteogenesis
It is a biological process of new bone formation between the surface of osteomized bone segments that are separated gradually by incremental traction.

4. Distraction osteogenesis
According to Arauson D.O is mechanically induced, intra- membranous ossification between two living bone surface acutely separated by low energy techniques undergoing gradual separation.

5. Distraction Osteogenesis
Tension within the callus stimulates new bon formation parallel to the vector of distraction.
Tension is created in the surrounding soft tissue leading to distraction histogenesis
( active histogenesis in skin ,fascia, blood vessels ,nerves ,ligament ,cartilage & periosteum ).

6. Illizarov 1951 Gavriil Abramovich Ilizarov
Tissue engineering slow gradual
distraction of osteomized bone
fragment.

7. The clinician is able to guide the formation of New Bone without growth factor or other controlling agents.

8. Dentofacial Traction Fauchard 1728 : expansion arrches
Wescott 1859 : correct cross-bite
Angel 1859 :rapid palatal expansion
Goddard 1893 : standarized the palatal expansion

9. Distraction Codvilla 1905 : first bone distraction femur
Abbot : tibia
Wassmund Rosenthal 1927 :first osteodistraction

10. Kazanjian 1937

11. Maxillofacial Region
The cranio facial skeleton are much more suited for distraction:
1-Membranous in embryological origin.
2-Smaller dimension.
3-Richer blood supply.

12. Distraction can be done for various Cranio-Facial Structure like :
1- Mandible.
2- Maxilla.
3- Zygoma.
4- Cranium.
5- Alveolar Bone.

13. Biomechanics of Distraction
Critical factors of the process:
1- Stability of fixation.
2- Rate of daily distraction.
3- Preservation of local soft tissue.
4- Vascular supply.

14. Classification of Distraction
Pure lengthening procedure
Corrective distraction osteo- tomies
Transportation distraction
Stimulation of growth

15. Target of Distraction Endochondral ossification
Intermittent compressive
Tensile stress
Intramembranous new bone formation
Constant compressive stresses
Chondrgenesis
Fibrous tissue formation
High shear stresses

16. Stages of D.O Clinically , D.O consists of five sequential stages:
1- Osteotomy.
2- Latency.
3- Distraction.
4- Consolidation.
5- Remodeling.

17. Fracture Healing Fracture healing Impact Induction Inflammation
Soft callus
Gradual traction
Hard callus
Remodeling

23. Before After

24. Before After