A quarter of a a century in craniomaxillofacial distraction osteogenesis. Where are we now; Where are we going?

Distraction osteogenesis has been one of the most innovative concepts in craniomaxillofacial surgery through the last 25 years. In 1987 Cesar A. Guerrero first performed a mandibular widening by distraction osteogenesis. Joseph G. McCarthy in 1992 published an extensive paper on the treatment of hemifacial microsomia. In 1994 Wangerin and Gropp and in 1996 Diner et al. published on the use of intraoral devices for mandibular distraction. After a quarter of century of extensive use Distraction Osteogenesis has today specific indications for congenital craniofacial and cleft deformities. Technology has evolved from the first application of external devices to intraoral and hybrid or semiburied techniques. In congenital craniomaxillofacial anomalies distraction is indicated during growth. Mandibular distraction osteogenesis can be safely and effectively used to avoid or remove tracheostomy in neonates with severe airway obstruction caused by micrognatia in Pierre Robin sequence. There is a great range of indications of DO in pediatric craniofacial deformities and this new concept seems to well combine the proven Tessier principle of “ first build, then move ”. On the other hand thorough Team evaluation needs to be esthablished prior to the surgical decision, and the indications of early distraction in neonates should be well-considered.