Craniofacial Disorders, Cleft Palate & Plastic Surgery

Providing innovative treatment for facial and skull disorders.

Distraction Osteogenesis

Distraction osteogenesis is an innovative treatment option in craniofacial surgery that is available at Rady Children's. The surgical treatment is a process where new bone is made across a bony cut (osteotomy).

First used in orthopedic surgery and later adapted by surgeons to treat children with abnormally recessed chins, distraction is a less invasive and safer technique for correcting certain types of craniofacial deformities. In addition, earlier treatment can be initiated; Rady Children’s youngest patient was a premature (35 weeks gestation) infant.

Surgeons in the Craniofacial Services Department at Rady Children’s have invented a variety of new devices used in distraction procedures to correct facial and skull deformities in children. The devices have been used overseas and throughout the United States at institutions such as Johns Hopkins Medical Center, UCLA and Stanford.

Midface Distraction

Dr. Steven R. Cohen, Chief of Craniofacial Surgical Services, is an international expert in midface distraction, using his invention, the Modular Internal Distraction System (FDA-approved in 1997). The technique divides the skull into two sections. Special plates are implanted beneath the skin to reattach them. Over a period of weeks, the plates are slowly pulled apart with the use of an expansion screw. Gradually, new bone grows in the gap between the plates, reshaping the skull.

10-year-old girl with Crouzon Syndrome who underwent a monobloc distraction with biodegradable devices.

Biodegradable Devices

Dr. Cohen and Dr. Ralph Holmes, Associate Chief of Craniofacial Services, are pioneers in the use of biodegradable devices in craniomaxillofacial surgery. They have worked closely with leading bioresorbable device makers to develop numerous new techniques that use fixation devices that eventually dissolve and are absorbed by the body.

Instead of metal plates, biodegradable devices are also being used in endoscopic craniofacial surgery to reduce the need for post-operative head molding. The Modular Internal Distraction System now has biodegradable distractor attachments (FDA-approved in June 2000), which permit easy device removal and shortened distraction times.

8-year-old girl with Pfieffer Syndrome who underwent a 30mm monobloc distraction.

Mandibular Distraction

Dr. Cohen was the first surgeon in the United States to perform neonatal mandibular distraction to prevent tracheostomy. Close relationships are necessary with pediatric otolaryngology and pediatric pulmonology to ensure a team approach to complex airway disorders. Mandibular distraction gradually advances the lower jaw and may be utilized earlier than conventional techniques.

Conditions Treated With Distraction

• Midface deficiency associated with cleft lip and palate
• Syndromic craniosynostosis such as Apert, Crouzon and Pfieffer syndromes
• Obstructive sleep apnea in children and young adults
• Pierre Robin sequence
• Selected tracheostomy dependent patients for decannulation
• Treacher Collins syndrome
• Nager syndrome

Distraction Treatment Options

Craniofacial Services offer a full range of distraction techniques including:

• Internal, buried devices
• Biodegradable and dissolvable devices
• External (R.E.D.) distraction
• Mandibular distraction with internal and external devices

In This Section

• Distraction Publications

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