Alvaro A Figueroa

• DDS, MS
• Managing Director at Rush University Medical Center

For pediatric patients with refractory temporomandibular joint (TMJ) ankylosis, reconstruction with autologous techniques such as costochondral grafts or distraction osteogenesis has long been considered the gold standard. Many surgeons believed the use of alloplastic joint replacement to be contraindicated in pediatric patients due to concerns for...

The purpose of this study is to analyze the angular variations within Cupid’s bow in patients with unoperated unilateral cleft lip (UCL). Angular features of Cupid’s bow were quantified in standardized presurgical photographs of children with UCL by 5 medical professionals specializing in craniofacial anomalies. The peaks and valley of Cupid’s bow...

Background: The use of a rigid external distraction (RED) is recognized as a viable treatment option for patients with severe maxillary and midface hypoplasia. However, there is limited research on the technical placement of the RED device and its impact on patient outcomes. This systematic review examined variations in RED placement as reported in...

In skeletally immature patients, costochondral grafts (CCG) are the standard of care for temporomandibular joint (TMJ) reconstruction; however, CCGs may undergo resorption or ankylosis, resulting in reoperation and a greater risk of surgical morbidity. While TMJ reconstruction with an alloplastic implant is done in skeletally mature patients, its u...

Background Crouzon syndrome is an autosomal dominant genetic disorder characterized by craniosynostosis, midface retrusion, and exophthalmos. Over the past century, the treatment of craniofacial disorders like Crouzon syndrome has evolved significantly. Methods An institutional review board–approved retrospective study was conducted to ascertain t...

Unilateral condylar hyperplasia (UCH) results in facial asymmetry, malocclusion, and temporomandibular joint dysfunction. Treatment consists of both surgical and orthodontic intervention. A review was performed for 4 patients with UCH who underwent digital surgical planning (DSP)-assisted condylectomy. All patients were female, aged 14 to 35 years...

Early mandibular distraction osteogenesis (MDO) can decrease upper airway and feeding complications in pediatric patients with micrognathia; however, temporomandibular joint (TMJ) complications like TMJ ankylosis (TMJA) may occur. TMJA can disturb pediatric patients' function and craniofacial growth, resulting in significant physical and psychosoci...

Background: Patients with Down syndrome have severe facial deformities that can precipitate functional consequences and social stigmatization. Craniofacial surgical intervention can play a role in improving these symptoms and patient quality of life. The objective of this study was to investigate the long-term outcomes of distraction osteogenesis...

Infantile cranial development typically occurs in a predictable sequence of events; however, less is known about how the development occurs in isolated, nonsyndromic congenital craniofacial anomalies. Furthermore, the timing of pediatric cranioplasty has been extrapolated from adult studies. Thus, the management of nonsyndromic congenital craniofac...

This chapter discusses the orthodontic planning and perisurgical management of maxillary distraction treatment for patients with orofacial clefts (OFCs). Selecting a distraction device for maxillary advancement in patients with OFC is based on several factors, which include age, skeletal discrepancy, malocclusion severity, dental development and in...

Introduction Presurgical infant orthopaedics (PSIO) in infants with cleft lip and palate focuses on improving the anatomical conditions of the lip, palate and nose before the first lip surgery; however, its effectiveness has not been proven. Objective To develop a core outcome set for reporting anthropometry-based outcomes in studies appraising th...

A 32-year-old female with a repaired right unilateral cleft lip and palate underwent several surgical and orthodontic procedures during the rehabilitation process of her condition. Nine years after this extensive treatment she underwent transverse relapse of her maxilla and requested a consultation for its correction as she felt her speech and chew...

Velopharyngeal dysfunction (VPD) is described as the incomplete closure of the velopharyngeal port during a speech production. Nasopharyngoscopy and/or multiplanar videofluoroscopy have been utilized for decades to assess the degree and nature of the dysfunction. Cone-beam computed tomography (CBCT) is presented as an additional diagnostic tool, al...

Midface advancement at the monobloc level can be the seminal life event for patients with craniofacial dysostosis. Monobloc reconstruction, when planned appropriately, can simultaneously and definitively address multiple functional and aesthetic deficiencies in these patients. The application of distraction has reduced the morbidity experienced wit...

Ameloblastomas are benign tumors that most commonly affecting the mandible. The current standard of treatment for ameloblastomas is resection followed by reconstruction that has historically been accomplished through the use of a microsurgical vascularized flaps taken from the iliac crest or fibula. Alloplastic reconstruction methods have gained po...

Distraction osteogenesis (DO) is a highly effective technique for correction of severe maxillary hypoplasia, especially in patients with orofacial clefts and craniofacial syndromes. The purpose of this retrospective, longitudinal study was to assess long-term airway alterations after maxillary advancement using a rigid external distraction system (...

Custom alloplastic temporomandibular joint (TMJ) reconstruction has been well established for the management of end-stage TMJ disease. However, its use in congenital TMJ deformities is limited. Here, the authors present initial outcomes of skeletally mature patients who underwent custom alloplastic TMJ reconstruction and simultaneous orthognathic s...

Many orthodontists working on patients with cleft lip and palate (CLP) have shown great enthusiasm for presurgical infant orthopedics (PSIO) to improve surgical outcomes with minimal intervention. Even though every clinician aims to use the best treatment modality for their patients, PSIO effects can be confounded by surgical type and timing of the...

The prevention of scar contracture after surgery is an important aspect of lateral facial cleft repair. Maintaining adequate mouth opening is essential for speech, expression, chewing, oral hygiene and psychosocial well-being. Although there have been extensive reviews of non-surgical microstomia management in patients with oral electrical burns, t...

Hemifacial microsomia is a deformity of variable expressivity with unilateral hypoplasia of the mandible and the ear. In this study, we evaluated skeletal soft tissue changes after bimaxillary unilateral vertical distraction. Eight patients (4 preadolescents 4 adolescents) each with a grade II mandibular deformity underwent a LeFort I osteotomy and...

Introduction Distraction osteogenesis is a powerful tool in craniomaxillofacial surgery, allowing for large advancements of osteotomized segments in the setting of a restrictive soft tissue envelope. Despite its benefits, distraction can have negative functional consequences. We present a case of a patient with Crouzon syndrome who developed reduce...

A skeletal positioning method and apparatus includes a splint having a main body coupled to a skeletal structure of a patient and a positioning guide having a skeletal footplate, a splint footplate, and an arm coupling the skeletal footplate and the splint footplate, the skeletal footplate including at least one aperture formed therein and the spli...

Background: Few publications have described the flap design of the secondary cleft alveoloplasty. In this article we describe a modified technique of the classical flap design with the purpose of minimizing injury to the dental papillae and periodontium of the involved dentition. We report our long-term experience, specifically with regards to oron...

Distraction Osteogenesis (DO) became an alternative for the treatment of severe craniofacial skeletal dysplasias. The rigid external distraction device (RED) is successfully used to advance the maxilla and all the maxillary-orbital-frontal complex (monobloc) in children, adolescents and adults. This approach provides predictable and stable results,...

Purpose: To introduce the concept and use of an occlusal-based "orthognathic positioning system" (OPS) to be used during orthognathic surgery. Materials and methods: The OPS consists of intraoperative occlusal-based devices that transfer virtual surgical planning to the operating field for repositioning of the osteotomized dentoskeletal segments...

A multidisciplinary conference was convened in March 2010 with the charge to develop parameters of care for patients with craniosynostosis. The 52 participants represented 16 medical specialties and 16 professional societies. Herein, we present the dental, orthodontic, and surgical care recommendations for those with craniosynostosis, with special...

Introduction: A multidisciplinary conference was convened in March 2010 with the charge to develop parameters of care for patients with craniosynostosis. The 52 participants represented 16 medical specialties and 16 professional societies. Herein, we present the dental, orthodontic, and surgical care recommendations for those with craniosynostosis,...

Craniosynostosis: Developing Parameters for Diagnosis, Treatment, and Management Introduction/Background: A multidisciplinary meeting was held from March 4-6, 2010, in Atlanta, Georgia, USA, sponsored by the Centers for Disease Control and Prevention (CDC) entitled Craniosynostosis: Developing Parameters for Diagnosis, Treatment, and Management....

A multidisciplinary meeting was held from March 4 to 6, 2010, in Atlanta, Georgia, entitled "Craniosynostosis: Developing Parameters for Diagnosis, Treatment, and Management." The goal of this meeting was to create parameters of care for individuals with craniosynostosis. Fifty-two conference attendees represented a broad range of expertise, includ...

Purpose: Nasal reconstruction for patients with unilateral cleft lip and palate (UCLP) is a challenge for the reconstructive surgeon. Presurgical nasoalveolar molding (PNAM) was introduced to reshape the cleft nasal structures prior to lip repair. This study analyzed two-dimensional nasal changes before and after PNAM in patients with complete UCL...

Distraction osteogenesis is effective for correction of severe maxillary and midface hypoplasia. The vectors controlling the segment to be moved must be planned. This requires knowledge of the physical characteristics of the osteotomized bone segment, including the location of the center of mass (free body) and the center of resistance (restrained...

Objective This retrospective study was conducted to analyze changes in the maxillary permanent molars after monobloc advancement with rigid external distraction (RED). Setting University hospital–based craniofacial center. Materials and Methods Fourteen patients, three in primary, eight in mixed, and three in permanent dentition underwent monoblo...

Objective: This retrospective study was conducted to analyze changes in the maxillary permanent molars after monobloc advancement with rigid external distraction (RED). Setting: University hospital-based craniofacial center. Materials and methods: Fourteen patients, three in primary, eight in mixed, and three in permanent dentition underwent m...

Maxillary Distraction

Distraction osteogenesis has become a treatment alternative to treat severe craniofacial skeletal dysplasias. A rigid external distraction device has been successfully used to advance the maxilla as well as the maxillary, orbital, and forehead complex (monobloc) in children as young as 2 years, adolescents, and adults. For this severe group of pati...

Objective: This retrospective study was conducted to analyze changes in the maxillary permanent molars after monobloc advancement with rigid external distraction (RED). Setting: University hospital–based craniofacial center. Materials and Methods: Fourteen patients, three in primary, eight in mixed, and three in permanent dentition underwent monobl...

Authors – Figueroa AA, Polley JW Distraction Osteogenesis (DO) has become a treatment alternative to treat severe craniofacial skeletal dysplasias. A rigid external distraction (RED) device has been successfully used to advance the maxilla as well as the maxillary, orbital and forehead complex (monobloc) in children as young as two years, adolescen...

The aim of this pilot study was to histologically evaluate the effect of bilateral vertical mandibular distraction osteogenesis (DO) on the temporomandibular joint (TMJ) in a canine model. Eight male beagle dogs underwent DO, with the placement of single-vector internal distractors. One unoperated animal served as control. After a latency period of...

We introduce a new technique for harvesting cancellous bone, the pubic bone graft. The pubic bone graft is a predictable and efficient technique that yields an ample harvest of rich cancellous bone. With experience gained from multiple fresh cadaver dissections, we present this technique in detail, including our most recent clinical application to...

To present technical modifications to the original presurgical nasal remodeling appliance introduced in 1991. The purpose of the modifications is to improve the cleft nasal deformity before unilateral and bilateral cleft lip repair. The principle behind this technique, known as dynamic presurgical nasal remodeling (DPNR), is the use of the force ge...

The aim of this study was to quantify bone microarchitecture within the glenoid fossa and mandibular condyle following mandibular distraction osteogenesis. Eight 6- to 9-month-old male beagle dogs underwent bilateral vertical mandibular distraction with semiburied distractors (12 days of distraction at 1 mm per day). One unoperated animal served as...

Mandibular ramus height restoration by distraction osteogenesis (DO) is a key procedure in mandibular hypoplasia reconstruction. The objective of this study was to evaluate short-term skeletal changes in the regenerated bone after vertical mandibular ramus DO using a buried distraction device. Eight subadult beagle dogs underwent bilateral vertical...

The sequelae of temporomanibular joint (TMJ) ankylosis include limitation of jaw movement, interference of oral function and affects on the craniofacial growth. Analysis of the craniofacial form of TMJ ankylosis offers guidelines for managing this disease. Forty-five patients with intraarticular TMJ ankylosis were collected from the files at the Ch...

Rigid external distraction is a highly effective technique for correction of maxillary hypoplasia in patients with orofacial clefts. The clinical results after correction of sagittal maxillary deformities in both the adult and pediatric age groups have been stable. The purpose of this retrospective longitudinal cephalometric study was to review the...

Rigid external distraction is a very powerful technique for reconstruction of patients with both congenital and acquired severe caraniomaxillofacial disorders. Patients with extensive bone loss or dysgenesis in the facial skeleton traditionally challenged our standard reconstructive procedures. Distraction osteogenesis through rigid external distra...

The purpose of this report is to present the application of distraction osteogenesis (DO) to the correction of mandibular deformities. DO is a technique used to lengthen bones after a cut is made within the bone and the segments are gradually separated, creating new bone between them. Elongation of the mandible improves the deficient bone structure...

The purpose of this study was to describe changes in articulation and velopharyngeal function following maxillary distraction osteogenesis. This is a descriptive, post hoc clinical report comparing the performance of patients before and after maxillary distraction. The independent variable was maxillary distraction while the dependent variables wer...

Objective The purpose of this study was to describe changes in articulation and velopharyngeal function following maxillary distraction osteogenesis. Design This is a descriptive, post hoc clinical report comparing the performance of patients before and after maxillary distraction. The independent variable was maxillary distraction while the depen...

In recent years, distraction osteogenesis has been used to correct skeletal disharmonies in the craniofacial region including the mandible and maxilla. Rigid external distraction has been used successfully to correct severe maxillary skeletal discrepancies. However, the characteristics of the newly formed bone have not been studied. A modified tomo...

The purpose of this study was to describe changes in articulation, resonance, and velopharyngeal function following mandibular distraction osteogenesis. This is a descriptive, post hoc study comparing the performance of patients on measures of articulation, resonance, and velopharyngeal function before and after mandibular distraction. The data wer...

Objective The purpose of this study was to describe changes in articulation, resonance, and velopharyngeal function following mandibular distraction osteogenesis. Design This is a descriptive, post hoc study comparing the performance of patients on measures of articulation, resonance, and velopharyngeal function before and after mandibular distrac...

Objective: To review current information on craniofacial growth of unoperated patients with craniofacial malformations and stimulate the study of abnormal craniofacial growth through conventional and newer methods. This will lead to improved diagnosis and the understanding of the etiopathogenesis of craniofacial malformations. It is expected that...

This study was conducted to evaluate the soft tissue profile changes after maxillary advancement with distraction osteogenesis (DO). Sixteen subjects underwent maxillary advancement with rigid external distraction after a high Le Fort I osteotomy. There were 11 male and 5 female patients, ages 5.2 to 25.7 years. The subjects included 9 with unilate...

Objective and Purpose To review current information on craniofacial growth of unoperated patients with craniofacial malformations and stimulate the study of abnormal craniofacial growth through conventional and newer methods. This will lead to improved diagnosis and the understanding of the etiopathogenesis of craniofacial malformations. It is expe...

Patients with cleft lip and palate with severe maxillary retrusion usually have a mandible with anterior-superior autorotation and subsequent overclosure and loss of the vertical facial dimension. Maxillary distraction osteogenesis can correct the sagittal maxillomandibular relationship and should simultaneously reestablish vertical dimension throu...

Objective: We present a possible negative side effect of a sudden onset of secretory otitis media in a 12-year-old boy with unilateral cleft lip and palate who underwent maxillary expansion. The secretory otitis media caused a temporary hearing loss developed during the activation of the expander appliance. The possible causes for this complicatio...

Objective We present a possible negative side effect of a sudden onset of secretory otitis media in a 12-year-old boy with unilateral cleft lip and palate who underwent maxillary expansion. The secretory otitis media caused a temporary hearing loss developed during the activation of the expander appliance. The possible causes for this complication...

Orthodontic tooth movement through recently distracted fibrous bone tissue has not been investigated previously. We hypothesized that a tooth can be moved into the fibrous new bone created by the distraction process at a rapid rate. Four mature beagle dogs were used in this study. An edentulous space was created in 2 weeks by using a bone-borne int...

This study analyzed in three dimensions the longitudinal growth pattern of young patients with hemifacial microsomia (HFM) before and after mandibular distraction osteogenesis (DO). Six individuals with HFM (five boys and one girl; age at distraction, 12.5 +/- 2.4 years) were treated with similar procedures (surgery, type and direction of distracti...

The completely osteotomized dentomaxillary complex is essentially a free body constrained only by its soft tissue attachments. Therefore the line of action and point of application of any protractive force(s) used during distraction osteogenesis must be considered relative to its center of mass. This is in contrast to the nonsurgically separated de...

The effect of maxillary advancement on speech may have benefits on articulation improvement but compromises velopharyngeal (VP) closure by increasing the nasopharyngeal distance. The purpose of this study was to evaluate the static VP anatomic changes on lateral cephalograms in patients who underwent maxillary advancement through distraction osteog...

The purpose of this study is to explore the possibility of bone formation in distraction osteogenesis of the free interpositional membranous bone. Three canine dogs were used as subjects. Two mandibular osteotomies were made in the mandibular body. The oral soft tissue and periosteum of the segment between the two osteotomies were freed from perios...

Maxillary hypoplasia is a common finding in patients with repaired orofacialclefts. Management of this condition has been a challenge to the reconstructive team. The introduction of distraction osteogenesis to treat craniofacial skeletal dysplasias has opened alternative approaches to manage these severe conditions. In this article, the authors pre...

The purpose of this study is to explore the possibility of bone formation in distraction osteogenesis of the free interpositional membranous bone. Three canine dogs were used as subjects. Two mandibular osteotomies were made in the mandibular body. The oral soft tissue and periosteum of the segment between the two osteotomies were freed from perios...

Distraction osteogenesis has become an important technique to treat craniofacial skeletal dysplasia. In this study, the technique of maxillary distraction with a rigid external distraction device is presented. Cephalometric results in the first 14 consecutive patients are analyzed. The study sample consisted of 14 patients with various cleft types...

In 1992 McCarthy opened new horizons in craniofacial surgery with the publication of the first application of distraction osteogenesis in the human craniofacial skeleton (1). Since the introduction of this pioneering work, distraction osteogenesis has rapidly become the keystone for the reconstruction of many craniomaxillofacial anomalies. For the...

The application of distraction osteogenesis in craniomaxillofacial surgery has created new treatment methods for patients with craniofacial skeletal dysplasias. Most of the applications in the craniofacial skeleton have been for the correction of severe congenital or acquired conditions. As more understanding is gained with these new approaches, re...

Patients with severe maxillary deficiency secondary to orofacial clefting present multiple challenging problems for the reconstructive team. These patients exhibit multidimensional maxillary hypoplasia and skeletal clefting with absence of maxillary and alveolar bone, as well as scarring, residual fistulas, and dental anomalies. Traditional surgica...