Spoke to a local Maxillo Surgeon about Distraction Osteogenesis

[ImpressionableYouth]

So I was looking at possible alternatives to traditional double jaw surgery in terms of advancing the mandible and upper jaw and came across some threads here about IMDO. I read that DO is a lot less invasive, recovery is a lot quicker, and the results a lot more dramatic (in comparison to jaw surgery), where you can get 1.5 cm of growth with the devices they attach.

However, my surgeon said that DO is still at a place where many surgeons will only do it for severe deformed mandibles/maxillas. So even if you are recessed, unless you have cleft palate or some kind of horrendous skull/mandible deformity, doctors will probably not give you DO.

tl;dr, if you need advancement, you're gonna have to stick with traditional DJS. DO isn't an option, and doctors aren't open to it quite yet.

 

[Gaia262]

So I was looking at possible alternatives to traditional double jaw surgery in terms of advancing the mandible and upper jaw and came across some threads here about IMDO. I read that DO is a lot less invasive, recovery is a lot quicker, and the results a lot more dramatic (in comparison to jaw surgery), where you can get 1.5 cm of growth with the devices they attach.

However, my surgeon said that DO is still at a place where many surgeons will only do it for severe deformed mandibles/maxillas. So even if you are recessed, unless you have cleft palate or some kind of horrendous skull/mandible deformity, doctors will probably not give you DO.

tl;dr, if you need advancement, you're gonna have to stick with traditional DJS. DO isn't an option, and doctors aren't open to it quite yet.

@Sergio-OMS thoughts?

 

[RealSurgerymax]

More that can go wrong.

 

[Chintuck22]

More that can go wrong.

Hey hey

Can you elab

 

[Gaia262]

I love when mysterious guys say random shit and don't elab anything

Dude show some fucking respect thats a maxilofacial surgeon.

 

[Chintuck22]

Dude show some fucking respect thats a maxilofacial surgeon.

Bro i've edited comment, that wasn't me saying that

 

[RealSurgerymax]

Hey hey

Can you elab

Sure,

The re-operation rate is much higher in distraction osteogenesis advancement compared to a standard plated one and done.

This is because now you have 2 distractors that can technically fail or become infected. Tissue-to-tissue surgery rarely becomes infected because the microbial load to actually “take” is nearly 100 times higher. However implant surgery which is tissue-to-implant-to-tissue has a substantially higher infection rate because non-living materials obviously can’t defend against bacteria providing a surface for the bacteria to form a biofilm on (antibiotics won’t work).

While there are plates and screws in regular jaw surgery which are by definition implants, distractors exit the skin or mucosa creating communication with the outside.

Also unintended “distraction vector” that is distracting the bone in a direction that was not planned.

It really doesn’t have a lower complication rate, if anything has more, and it is far from more pleasant:

Complications of Mandibular Distraction Osteogenesis : Journal of Craniofacial Surgery

to a wide variety of complications. Methods: The PubMed database was queried for all articles describing complications of MDO. Each article was then reviewed, and relevant data were extracted and compiled. Finally, several case reports are presented to illustrate poignant examples of...

journals.lww.com

 

[Sergio-OMS]

@Sergio-OMS thoughts?

IMDO in teens is way better than alternatives, like Herbst or similar appliances, and better than waiting for a BSSO.

In adults over 40ish risks overcome benefits, in my opinion, compared to BSSO.

Between 16-40... it really depends, I explain the options and let the patient decide. The younger the patient the lower the risks and the higher the benefits.

IMDO needs some training and the use of the adequate devices and instruments. If the protocol is followed, it works very well.

Only a few of us (5) are doing IMDO the right way.

 

[ImpressionableYouth]

Hey hey

Can you elab

@RealSurgerymax posted a lot of good info.

Also, from speaking with the surgeon, he mentioned one of the biggest issues which has a rather high chance of occurring is uncontrolled vectors of growth. Clearly, the desired direction is forward, but there is a chance that the surgeon won't know to what level the growth will work favorably, it's a wildcard. It's up to the devices, really.

So on paper DO is awesome, but in reality, it still seems very uncharted and like @Sergio-OMS mentioned, it sounds like surgeons aren't even getting proper training for it, except for a select few.

 

[RealSurgerymax]

@RealSurgerymax posted a lot of good info.

Also, from speaking with the surgeon, he mentioned one of the biggest issues which has a rather high chance of occurring is uncontrolled vectors of growth. Clearly, the desired direction is forward, but there is a chance that the surgeon won't know to what level the growth will work favorably, it's a wildcard. It's up to the devices, really.

So on paper DO is awesome, but in reality, it still seems very uncharted and like @Sergio-OMS mentioned, it sounds like surgeons aren't even getting proper training for it, except for a select few.

Yes I acknowledge that IMDO is a refined and specific version of mandibular Distraction. Similar to how MSE is a version of MARPE and undoubtedly the best.

The second issue is that even if the mandible is perfectly advanced, you have the upper jaw to worry about too. Distracting both at the same exact time and hoping that both line up just right doesn’t sound like a very good idea.

So I could view it as a much more reasonable option if the person was moderately to severely Class II and needed a mandibular advancement only. But most people here are seeking aesthetic jaw surgery which is almost always going to be a double jaw surgery.

Further, a lot of people are traveling for surgery because this community is very choosey about what they get (which is a good thing). Managing a distraction process from out of the area would also not be realistic for most people here. It would require the person either stay there for a while, fly there multiple times, or find a local cooperating practitioner to supervise the process.

 

[Sergio-OMS]

Yes I acknowledge that IMDO is a refined and specific version of mandibular Distraction. Similar to how MSE is a version of MARPE and undoubtedly the best.

The second issue is that even if the mandible is perfectly advanced, you have the upper jaw to worry about too. Distracting both at the same exact time and hoping that both line up just right doesn’t sound like a very good idea.

So I could view it as a much more reasonable option if the person was moderately to severely Class II and needed a mandibular advancement only. But most people here are seeking aesthetic jaw surgery which is almost always going to be a double jaw surgery.

Further, a lot of people are traveling for surgery because this community is very choosey about what they get (which is a good thing). Managing a distraction process from out of the area would also not be realistic for most people here. It would require the person either stay there for a while, fly there multiple times, or find a local cooperating practitioner to supervise the process.

In the IMDO cases I’ve done I used MSE and asked the orthodontist to procline the upper front teeth to create more overjet. But there is no doubt that surgical advancement with a Le Fort after MSE would have been better, patients refused or were too young to offer.

 

[Deusmaximus]

@Sergio-OMS @RealSurgerymax
I have extreme crowding and very narrow mandible situation with toris mandibulare. What would be the best fix?

 

[Sergio-OMS]

@Sergio-OMS @RealSurgerymax
I have extreme crowding and very narrow mandible situation with toris mandibulare. What would be the best fix?

View attachment 696661

Going to an orthodontist.

 

[Lev Peshkov]

Good luck bro

@Hozay
@PYT
@Mohamad
@xefo69

Look at this!

 

[Deusmaximus]

Going to an orthodontist.

I consulted a couple. They would all only give my braces and extract one teeth. All the orthos told me mse/msdo is to heavy, risky and invasive, because also my bite is "not deformed". But i think its because almost no ortho in my country is performing mse/msdo.
One offered me a strange form of frontblock distractor like this:

 

[Sergio-OMS]

I consulted a couple. They would all only give my braces and extract one teeth. All the orthos told me mse/msdo is to heavy, risky and invasive, because also my bite is "not deformed". But i think its because almost no ortho in my country is performing mse/msdo.
One offered me a strange form of frontblock distractor like this:

View attachment 696734

Obviously they don’t want to be part of it. Then you should be looking for options, or accept that plan... or just do nothing...

 

[Sergio-OMS]

Obviously they don’t want to be part of it. Then you should be looking for options, or accept that plan... or just do nothing...

You know, actually and anterior semental osteotomy could be an option ... and also corticotomies with grafting. There are options, you must choose.

 

[RealSurgerymax]

@Sergio-OMS @RealSurgerymax
I have extreme crowding and very narrow mandible situation with toris mandibulare. What would be the best fix?

View attachment 696661

I consulted a couple. They would all only give my braces and extract one teeth. All the orthos told me mse/msdo is to heavy, risky and invasive, because also my bite is "not deformed". But i think its because almost no ortho in my country is performing mse/msdo.
One offered me a strange form of frontblock distractor like this:

View attachment 696734

I think you should keep consulting more.

I am not an orthodontist but perhaps a quad helix? You could ask them about that... It isn't invasive.

Also try emailing them if you can find that contact info so you don't waste your time in 15 consults.

As far as the tori, those can be burred off by oral surgeon.

 

[Agendum]

T

I consulted a couple. They would all only give my braces and extract one teeth. All the orthos told me mse/msdo is to heavy, risky and invasive, because also my bite is "not deformed". But i think its because almost no ortho in my country is performing mse/msdo.
One offered me a strange form of frontblock distractor like this:

View attachment 696734

Those are some shitty ortho's if they think MSE is risky and invasive jfl.
Go to a sleep apnea oriented Ortho, they'll understand the pain of a narrow palate.

 

[SPFromNY914]

Yes I acknowledge that IMDO is a refined and specific version of mandibular Distraction. Similar to how MSE is a version of MARPE and undoubtedly the best.

The second issue is that even if the mandible is perfectly advanced, you have the upper jaw to worry about too. Distracting both at the same exact time and hoping that both line up just right doesn’t sound like a very good idea.

So I could view it as a much more reasonable option if the person was moderately to severely Class II and needed a mandibular advancement only. But most people here are seeking aesthetic jaw surgery which is almost always going to be a double jaw surgery.

Further, a lot of people are traveling for surgery because this community is very choosey about what they get (which is a good thing). Managing a distraction process from out of the area would also not be realistic for most people here. It would require the person either stay there for a while, fly there multiple times, or find a local cooperating practitioner to supervise the process.

I'm class 2 and imdo sounds perfect for me after I'm done with MSE

 

[SPFromNY914]

In the IMDO cases I’ve done I used MSE and asked the orthodontist to procline the upper front teeth to create more overjet. But there is no doubt that surgical advancement with a Le Fort after MSE would have been better, patients refused or were too young to offer.

So you're saying Bimax after MSE is better than IMDO after MSE? How bout for example my case where I have a class 2 and both jaws are recessed/narrow? I'm 18 and probably will be 19/20 when I'm done with MSE and Invisalign...
I would appreciate it a ton if you can awnser Doc

 

[Sergio-OMS]

So you're saying Bimax after MSE is better than IMDO after MSE? How bout for example my case where I have a class 2 and both jaws are recessed/narrow? I'm 18 and probably will be 19/20 when I'm done with MSE and Invisalign...
I would appreciate it a ton if you can awnser Doc

Every patient is different, don’t generalise. And if you are really looking for maxillomandibular surgery don’t start any treatment without letting your orthodontist know about this.

 

[everythingmatters]

Only a few of us (5) are doing IMDO the right way.

Could you name who are those 5 surgeons please?

 

[Deleted member 6756]

Could you name who are those 5 surgeons please?

 

[Deleted member 2729]

IMDO in teens is way better than alternatives, like Herbst or similar appliances, and better than waiting for a BSSO.

In adults over 40ish risks overcome benefits, in my opinion, compared to BSSO.

Between 16-40... it really depends, I explain the options and let the patient decide. The younger the patient the lower the risks and the higher the benefits.

IMDO needs some training and the use of the adequate devices and instruments. If the protocol is followed, it works very well.

Only a few of us (5) are doing IMDO the right way.

What benefits does imdo have over bsso?