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CASE STUDY //

Osteogenesis: Filling the Gaps

A two-year-old patient now eats and breathes easier thanks to a minimally invasive bone-growing technique.

By Brandon Keim // The MGH Research Issue 2011
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distraction

Justin Gabbard

Two-year-old Kelly O’Laughlin was born with a condition called severe micrognathia—a jaw so small she needed a tracheostomy to make sure her airway didn’t become blocked and stop her from breathing when she slept. “She was eating through a tube,” says Maria Troulis, an oral and maxillofacial surgeon at MGH.

Troulis specializes in minimally invasive surgical techniques, including distraction osteogenesis—a procedure in which a device gradually separates a bone’s edges after it has been cut so that bone-forming cells flood the gap. Popularized by a Russian orthopedic surgeon confronted with horrific battlefield injuries during World War II, it now benefits children like Kelly O’Laughlin.

Troulis and MGH distraction osteogenesis pioneer Leonard Kaban used distraction-guiding software to calculate the trajectories of implants that eased apart O’Laughlin’s delicate 24-month-old jawbones by a fraction of an inch each day. The adjustments were made by twisting activating arms protruding from a single tiny incision, and her jaw was lengthened by more than two inches in three months. “We were able to remove the tracheostomy,” Troulis says. “She can eat normally. She could develop regular speech.”

Troulis and Kaban hope that within the next few years, a remotely controlled distraction implant, now being tested in miniature pigs, will be ready to try in people.

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Filling the Gap

Distraction osteogenesis

Break a bone and pull it apart a millimeter a day. Seems crazy, but distraction osteogenesis is saving legs, arms and faces.

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