Rodgers, William; (2021) Development of a Personalised 3D Mandibular Distraction Device for the Management of Craniofacial Microsomia. Doctoral thesis (M.D(Res)), UCL (University College London).

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Abstract

Introduction: Surgical correction of the facial skeleton in deformity has evolved significantly over the recent past as techniques and technology have improved. Where there exist significant skeletal discrepancies, large skeletal changes are required and there remains a need to further improve upon our current standard to achieve these surgical goals. Distraction osteogenesis (DO) is a technique that induces bone formation without the need for bone grafting and allows for guided shape change in addition to expanding the overlying tissue envelope. Current mandibular distractors are limited as they are bulky; there are wound problems related to the external siting of the actuator; there is a limited geometry of possible distraction; the final result is unpredictable; they function in a discontinuous rather than continuous motion and they require daily winding by the patient. There exists a clear potential benefit to patients should these drawbacks be overcome. Aim: The aim of the project is to design a novel device to modify the shape of the deformed jaw to a prescribed, predetermined shape that is specific to the patient and that does not require external manipulation. Methods: The mechanical properties of helical springs constructed from a nonlinear material were tested to review their suitability for use as actuators to deliver force in a fully buried continuous distractor. A finite element model was then created to generalise the concept for use where different forces may be required. Lastly a prototype was designed and empirically tested ex-vivo to assess whether the aims of the project were fulfilled. Results: The nonlinear material was found to deliver adequate, continuous and relatively constant force over a distance in keeping with DO. The finite element model was demonstrated to accurately represent the empirical properties of the helical spring. The prototype designed was able to modify the shape of a deformed jaw to a predetermined position without requiring external manipulation in a surgical model. Discussion: This project develops and tests a prototype that is fully buried and can achieve multiplanar continuous DO without the need for patient involvement and therefore provides novel technology as a solution to improving practice.

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