Reconstruction of mandibular symphyseal defects by trifocal distraction osteogenesis: an experimental study in Rhesus.

Mandibular symphyseal defects caused by tumor surgery, trauma, or congenital misshape can produce maxillofacial deformity and functional handicap. Recently, the technique of distraction osteogenesis has become a valuable reconstructive method for craniofacial bone defects. Four adult rhesus monkeys were used in this study. The anterior mandibulectomy (ranged from canine to canine) was performed, and bilateral transport segments (ranged from first premolar to first molar) were created. Custom-made multiplanar distractors were applied for the reconstruction of the monkeys' artificial mandibular symphyseal defects by trifocal distraction osteogenesis. After a delay period of 7 days, the bilateral transport discs were distracted forward and inward simultaneously. Serial X-ray and three-dimensional CT films were taken within the experimental period. Two monkeys were sacrificed at 8 and 16 weeks, respectively, after the completion of distraction. The distracted calluses and united areas between bilateral transport discs were harvested and processed for histological examination. The mandibular symphyseal defects in all animals were repaired successfully and the anterior mandibular contours were similar to the normal ones. Perfect bone regeneration in the distraction gaps was found, and fibro-bony union between the bilateral transport segments was observed in the midline region at 16 weeks after the end of distraction. The success of distraction osteogenesis for repair of mandibular symphseal defects in monkeys by this distractor may provide an alternative method to reconstruct the anterior part of mandible.