Craniomaxillofacial (CMF) Distraction System. A modular family of ...

Craniomaxillofacial (CMF) DistractionSystem. A modular family of internaldistraction devices to lengthen the mandi-bular body and ramus.

Technique Guide

Introduction

Surgical Technique

Product Information

Bibliography

Craniomaxillofacial (CMF) Distraction System 2

Indications 4

Preoperative Planning 5

Distractor Assembly 6

Mandible Body Lengthening 17

Postoperative Management 25

Extension Arm Removal 28

Device Removal 30

Implants 31

Screws 36

Instruments 38

Set 44

45

Table of Contents

Synthes 1

+ + =

1.0 mm 1.3 mm

1.5 mm 2.0 mm

1.0 mm 1.3 mm

1.5 mm 2.0 mm

2 Synthes Craniomaxillofacial (CMF) Distraction System Technique Guide

Craniomaxillofacial (CMF) DistractionSystem. A modular family of internaldistraction devices to lengthen themandibular body and ramus.

A modular system of intraoral distraction devices offered in avariety of designs and sizes to fit patient anatomy.

Footplates– Available in cloverleaf and mesh designs– Available in four sizes for use in a wide range of patients:

1.0 mm and 1.3 mm for children under 12 months of age,and 1.5 mm and 2.0 mm for older patients

– 2.0 mm footplates with threaded screw holes accept Syn-thes 2.0 mm titanium locking screws for greater stability

Cloverleaf footplates

2.0 mm titanium locking screw

Mesh footplates

Synthes 3

Rigid extension arm

Flexible extension arm

End-translating (BC distractor shown with universal joint)

Center-translating (AB distractor shown without universal joint)

Distractor bodies– Offered in center-translating (AB distractor) and endtrans-

lating (BC distractor) designs, for maximum placement op-tions of the distractor on the mandible

– Available with or without a universal joint. Universal jointsallow ±35º of angulation of extension arms

AB distractor bodies – Footplates can be placed more anteriorly on the mandible

with half of the distractor initially positioned posterior tothe osteotomy

BC distractor bodies– Footplates can be placed more posteriorly on the mandible

with the distractor body initially positioned either anterioror posterior to the osteotomy, depending on the orienta-tion

Extension arms – Allow the point of activation to be moved away from the

distractor body for easier access with the activation instru-ment

– May be placed intraorally or percutaneously– May be removed for patient comfort, during the consolida-

tion phase, without a surgical procedure


The Synthes Craniofacial (CMF) Distraction System is in-tended for use as a bone stabilizer and lengthening (and/ortransport) device for correction of congenital deficiencies orpost-traumatic defects of the mandibular body and ramuswhere gradual bone distraction is required. The system of 1.0 mm and 1.3 mm is recommended for children under theage of 12 months and 1.5 mm and 2.0 mm is recommendedfor older patients.

Indications

Synthes 5

Preoperative Planning

Determine the postdistraction anatomic goal by conductingan evaluation of the craniofacial pathology and asymmetrythrough clinical exam, CT scan, cephalogram and/orpanoramic x-ray. Anatomical models are beneficial for select-ing appropriate distractor components, determining the loca-tion of the osteotomy and placement of the devices, and forpre-bending the footplates.


Distractor Assembly

A-stylefootplate

B-stylefootplate

C-stylefootplate

2Select footplates

Select two footplates according to the treatment plan andchosen distractor design, giving special consideration to thepatient’s anatomy.

Note: Footplates must mate with the selected distractorbody. If an AB distractor body is selected, one A-style andone B-style footplate must be used. If a BC distractor body isselected, one B-style and one C-style footplate must be used.

1Select distractor body

Select the appropriate design and length distractor body ac-cording to the treatment plan.

Note: To ensure that the soft tissue does not obstruct the ac-tivation hex during distraction, the next longer size distractorbody and/or extension arm may need to be used.

BC distractor body (end translating) shownwith universal joint and 1.5 mm mesh footplates

AB distractor body (center translating) shown with 1.5 mm mesh footplates

Synthes 7

There are different steps for attaching the footplates to theAB and BC distractor bodies.

3aAssemble footplates-AB distractor

Instruments

311.005 Screwdriver Handle with hex coupling,small

311.006 Screwdriver Handle with hex coupling,medium

313.252 1.5 mm/2.0 mm Screwdriver Blade,self-retaining, PlusDrive, 96 mm


Use the 1.5 mm/2.0 mm screwdriver blade to remove themachine screw and collar from the distractor body.

Set these aside for later reassembly.

Remove the lead screw by sliding it out of the distractorbody.

collar


Thread the B-style footplate onto the hex end of the leadscrew and rotate the footplate counterclockwise until itreaches the center of the lead screw. An etched “B” alongwith an arrow on the center of the lead screw indicatesproper placement of the B-style footplate.

Distractor Assembly

hex end

non-hex end

Thread the A-style footplate onto the opposite end of thelead screw and rotate the footplate clockwise until it reachesthe center of the lead screw. An “A” and an arrow areetched on the center of the lead screw to assist in assem-bling the footplate.

– Align the footplates parallel to each other at the center ofthe lead screw.

– Position the footplates so that the screw holes point awayfrom one another, as shown.

Correct

Incorrect

hex end

Synthes 9

Insert the hex end of the lead screw (the end with the B-stylefootplate) back into the distractor body.

Slide the lead screw all the way into the distractor until itseats in the activation hex.

Retrieve the previously disassembled machine screw and collar.

Place the collar onto the distractor body. Etched lines on thecollar and distractor body aid in realignment.

Correct Incorrect


Distractor Assembly

Use the 1.5 mm/2.0 mm screwdriver blade to reinsert themachine screw into the collar and distractor body and fullytighten, locking the construct together.

Notes– Once the distractor is fully assembled, rotate the activation

hex counterclockwise to verify that the footplates aretranslating and the distractor is functioning properly. Thedistractor will not activate if the collar is not reattached orif the distractor is assembled improperly.

– Return the footplates to the original position by turningthe activation hex clockwise until the footplates reach thecenter of the distractor body.

– When the distractor is fully assembled, the slot on the dis-tractor body will face medially and the screw hole counter-sinks will face laterally.

Final AB distractor assembly with footplates in the home position

Underside of the final AB distractor assembly

screw hole countersinks

slot on the distractor body

Synthes 11

3bAssemble footplates-BC distractor

Instruments





Use the 1.5 mm/2.0 mm screwdriver blade to remove themachine screw from the distractor body.

Correct

Incorrect


Distractor Assembly

Insert the B-style footplate into the open end of the distrac-tor body in the correct orientation, as shown.

Note: The screw holes on the B-style footplate should bepositioned so that they point towards the activation hex andnot the open end of the distractor.

Turn the activation hex counterclockwise to engage the B-style footplate with the lead screw. Rotate the activationhex at least 6 full turns to allow room for the C-style foot-plate.

Technique tip: The activation instrument can be used toturn the activation hex.

Synthes 13

Attach the C-style footplate by fitting it over the open end ofthe distractor body.

Use the 1.5 mm/2.0 mm screwdriver blade to reinsert themachine screw into the distractor body and fully tighten,locking the construct together.

Note: Once the distractor is fully assembled, ensure that theB-style footplate is in the “home” position by turning the ac-tivation hex clockwise until the two footplates meet.

When the distractor is fully assembled, the slot on the dis-tractor body will face medially and the screw hole counter-sinks will face laterally.

Final BC distractor assembly with footplates in the home position

Underside of the final BC distractor assembly

screw hole countersinks

slot on the distractor body


Distractor Assembly

4Assemble extension arm (optional)

Instrument

03.315.004 Removal Instrument, for CMF Distractor

Determine if an extension arm will be needed to place theactivation hex in an area easily accessible with the activationinstrument.

Notes– To ensure that the soft tissue does not obstruct the activa-

tion hex during distraction, the next longer size extensionarm may need to be used.

– Extension arms can be removed from the distractor at thestart of the consolidation phase without the need for a surgical procedure (see page 28 for instructions).

collar

Synthes 15

Engage the removal instrument with the hex end of the ex-tension arm.

Rotate the removal instrument collar counterclockwise atleast 16 full turns until the hex pocket of the extension armis exposed.

Technique tip: Maintain constant finger pressure betweenthe extension arm and the removal instrument during thisstep.

Place the distractor body activation hex into the hex pocketof the extension arm.

Rotate the removal instrument collar clockwise until the ex-tension arm closes over the activation hex of the distractorbody, and tighten fully.

Distractor assembly with removable extension arm attached

5Assemble second distractor

For bilateral procedures, repeat steps 1 through 4 to assem-ble a distractor for the contralateral side.


Distractor Assembly

Mandible Body Lengthening

The following surgical technique is an example of an intrao-ral approach with the distractor placed in an anterior orienta-tion with intraoral activation. A similar technique can beused for placing the distractor in a posterior orientation witha percutaneous activation port. The distractor can also beplaced on the mandibular ramus.

1Make incision

Make a mandibular vestibular or a submandibular incision.Elevate the periosteum to expose the mandible.

Synthes 17


2Mark osteotomy

Mark the approximate site of the osteotomy.

3Fit distractor

Place a fully assembled distractor in the intended area to as-sess the patient’s anatomy and determine the approximatelocation of the footplates and extension arm.

Factors to consider include:– Occlusal plane– Tooth buds and roots– Planned vector of distraction– Adequate bone for screw placement– Location of mental nerve– Lip closure– Soft tissue (mucosa) coverage– Location of activation hex


Ideal Acceptable Not preferable

Optional technique: Alignment rods

Instrument

03.315.003 Alignment Rod, for CMF Distractor

Alignment rods can be used throughout the course of surgery to:– Aid in parallel placement of the devices– Indicate the vectors of advancement– Hold the distractors during screw fixation and device

placement

To use the alignment rods, place the open end of the align-ment rod over the distractor body or extension arm.

Synthes 19

Slide the alignment rod sleeve forward until it meets thethreaded portion of the rod and rotate clockwise until therod tightens onto the distractor.

Important: The alignment rods should not be used as lever-age for bending the footplates as this may cause damage tothe distractor bodies.

While parallel placement of the distractors is ideal, this maybe difficult to accomplish considering the patient’s soft tissuecoverage, and could potentially lead to patient discomfort. Aslight convergence of the distraction vector is acceptable toensure patient comfort.

The point of convergence should be farther from the patientfor larger advancements and can be closer to the patient forsmaller advancements.

4Cut and contour footplates

Instruments

03.500.014 Cutting Instrument

03.503.039 Plate Cutter

347.964 Combination Bending Pliers,for 1.0 mm and 2.0 mm plates

391.965 Combination Bending/Cutting Pliers,for 1.0 mm to 2.0 mm plates

Cut the footplates to remove any unnecessary screw holes.

Notes on cutting– Activate the distractor to separate the footplates to aid in

cutting.– Cut the footplates so the cut edges are flush with the dis-

tractor body.

Screws can be placed in the holes superior to the distractorbody in the posterior footplate and in the holes inferior tothe distractor body in the anterior footplate for added sta-bility.

Important: A minimum of three screw holes should remainin each footplate to ensure adequate stability.

Take care to avoid placing screws in tooth buds or roots.

Contour the footplates to the mandible using the combination bending pliers.



5Mark distractor location

Instruments



Optional instruments

397.211 Universal Trocar Handle

397.213 2.0 mm Cannula and Obturator

397.232 Malleable C-Retractor

397.420 2.0 mm Cheek Retractor Blade

397.430 2.0 mm Cheek Retractor Ring

Use the appropriate drill bit and screwdriver blade for thefootplate size selected.

Footplate Drill bit Screwdriversize size blade

1.0 mm 0.76 mm 1.0 mm

1.3 mm 1.0 mm 1.3 mm

1.5 mm 1.1 mm 1.5 mm or 1.5 mm/2.0 mm

2.0 mm 1.5 mm 1.5 mm/2.0 mm or 2.0 mm

Mark the position of the distractor before making the os-teotomy by drilling and/or inserting one appropriate lengthscrew through each footplate.

Do not fully tighten the screws.

Synthes 21


6Perform buccal corticotomy

Unscrew and remove the distractor.

Perform the corticotomy on the buccal side of the mandibleextending into the anterior and posterior borders. This allowsstability of the bone segment during replacement of the dis-tractor.


7Reattach distractor

Instruments



Use the prior selected appropriate drill bit and screwdriverblade for the footplate size selected (see page 21).

Reattach the distractor by aligning the footplates with theholes made previously. Drill and/or insert remaining screws.Fully tighten all screws.

Notes– A minimum of three screws should be inserted through

each footplate to ensure adequate stability.– Depending on patient anatomy and placement of the dis-

tractor, the extension arm can either remain in the intraoralcavity or project through a small percutaneous activationport. If the extension arm remains in the intraoral cavity,care should be taken to ensure that it does not interferewith the patient’s ability to eat.

– Extension arms can be secured below the dentition with aloop of wire attached to orthodontic brackets or to theteeth. The loop should restrict the vertical movement ofthe extension arm without affecting the arms’ ability to ro-tate. This will ensure that the extension arm does not in-terfere with mastication.

Synthes 23

8Complete osteotomy

Complete the osteotomy on the lingual aspect of themandible using an osteotome. Take care to avoid the nerve.

Important: The osteotomy must be complete and the bonemust be mobile. The distractor is not designed or intended tobreak bone and/or complete the osteotomy.

9Confirm device activation

Instruments

03.315.001 Activation Instrument, 1.7 mm

03.315.005 Activation Instrument, 1.7 mm, withU-Joint

Use an activation instrument to engage the activation hex of the distractor or extension arm. Rotate in a counterclock-wise direction, as marked on the handle, to confirm devicestability and verify movement of the mandible. Return thedistractor to its original position.

10Repeat steps for bilateral procedures

Repeat steps 1 –9 on the contralateral side.Close all incisions.



Postoperative Management

Suggested distraction protocol

Instruments


03.315.005 Activation Instrument, 1.7 mm, withU-Joint

It is recommended to begin active distraction three to fivedays after device placement. For young patients, active dis-traction can begin earlier to prevent premature consolida-tion.

To activate the distractors, engage an activation instrumentwith the activation hex and rotate counterclockwise (in thedirection of the arrow marked on the instrument).

The instrument can be made smaller for use in young pa-tients, by removing the blue machine screw.

Activation instrument

Activation instrument (with blue machine screw removed)

Synthes 25

Rate of activation The AB and BC distractors advance at different rates.

Notes– To accomplish a half-turn, rotate the activation instrument

from the side with the arrow marked on it to the side withthe open slot.

– A minimum of 1.0 mm of linear advancement per day isrecommended to prevent premature consolidation.

1 see Izadi et al., 493 –4992 see Mandell et al., 344 –3483 see Steinbacher et al. 1072 –79


Postoperative Management

1 full turn with activation instrument 0.70 mm of linear advancement 0.35 mm of linear advancement

Recommended number of turns perday based on patient age1, 2, 3

< 1 year old (1.8 mm/day) 2 ½ turns (1.75 mm) 5 turns (1.75 mm)

> 1 year old (1 mm/day) 1 ½ turns (1.05 mm) 3 turns (1.05 mm)

AB distractor BC distractor

Patient careIf the distractors are placed with the extension arms in theintraoral cavity, care must be taken to prevent the arms frominterfering with mastication. Extension arms can be securedbelow the dentition with a loop of wire attached to ortho-dontic brackets or to the teeth. The loop should restrict thevertical movement of the extension arm without affectingthe arm’s ability to rotate. This will ensure that the extensionarm does not interfere with mastication.

If the distractors are placed with the extension arms exitingthrough percutaneous ports, it is important that the exten-sion arms be protected from catching on objects that couldpull or deform the devices and cause the patient pain or in-jury. Extension arms can be taped or bandaged to the skin to prevent them from snagging on external objects.

ConsolidationAfter the desired advancement has been achieved, the newbone must be given time to consolidate. The consolidationperiod should be at least six to twelve weeks.2 This time pe-riod may vary in relation to patient age and should be deter-mined by clinical evaluation.

If the removable extension arms were used, they can be re-moved at the start of the consolidation phase.

Synthes 27

2 see Mandell et al., 344 –348

Extension Arm Removal

Instrument

03.315.004 Removal Instrument, for CMF Distractor

Engage the removal instrument with the extension arm.

Rotate the removal instrument collar counterclockwise atleast 16 full turns. This will unscrew the outer sleeve of theextension arm and expose the hex pocket where the exten-sion arm connects to the distractor.

Warning: When removing the extension arms, rotate onlythe collar of the removal instrument. Do not allow the baseof the removal instrument to rotate in your hand, as doing somay result in a change in the distraction distance that hasbeen achieved.

Disengage the extension arm from the distractor with side-to-side movements of the arm. Remove the extension armthrough the percutaneous port or intraoral cavity.

Note: The line etched on the extension arm corresponds tothe direction of the hex pocket opening at the top of the ex-tension arm. Pushing the extension arm in the direction ofthe line should disengage it from the distractor.

collar


Optional technique

Instruments


03.315.005 Activation Instrument, 1.7 mm withU-Joint

347.964 Combination Bending Pliers, for 1.0 mmand 2.0 mm plates

If the removal instrument is not available, the extension armscan be removed using an activation instrument and pliers.Engage the extension arm with the activation instrument.While holding the activation instrument still, use the pliers torotate the sleeve on the extension arm counterclockwise atleast 16 full turns to expose the hex pocket where the exten-sion arm connects to the distractor. Disengage the extensionarm from the distractor body with side-to-side movements.

Synthes 29

Device Removal

Instruments



Use the appropriate screwdriver blade for the footplate size used (see table step 5, page 21).

Remove the distractors by exposing the footplates, throughthe same incisions that were used during the initial place-ment surgery, and removing the titanium bone screws.

Note: The distractors are easier to remove if the extensionarms are removed before distractor removal. This will alsohelp keep the intraoral cavity from contacting the externallyexposed extension arm.


1.3 mm

1.5 mm 2.0 mm

1.0 mm 1.3 mm

1.5 mm 2.0 mm

1.0 mm

Footplates– Available in A, B, and C styles to mate with the selected

distractor body. Each footplate is etched with a style letterdesignation

– Available in four sizes: 1.0 mm and 1.3 mm for childrenunder 12 months of age; 1.5 mm and 2.0 mm for olderpatients

– Footplates are used with corresponding size titaniumbone screws

– 2.0 mm footplates accept Synthes 2.0 mm titanium locking screws

– Available in cloverleaf and mesh designs– Symmetrical for use on both sides of the mandible– Material: Commercially pure titanium

A-stylefootplate

B-stylefootplate

C-stylefootplate

Cloverleaf footplates

Mesh footplates

Implants

Synthes 31

Implants

Distractor bodies– Offered in center-translating (AB distractor) and end-trans-

lating (BC distractor) designs – Available with or without a universal joint– Materials: Titanium alloy (Ti-6AI-7Nb) and cobalt

chromium alloy (Co-20Cr-15W-10Ni)

Note: Allergic reactions may occur in patients previously sen-sitised to nickel.

AB distractor bodies – Center-translating distractor bodies work with A-style and

B-style footplates– Both footplates are positioned in the center of the distrac-

tor and move laterally away from one another when thedistractor is activated

– Footplates can be placed more anteriorly on the mandiblewith half of the distractor initially positioned posterior tothe osteotomy

– Available in 15 mm, 20 mm, 25 mm and 30 mm lengths

Collar

Machinescrew

BC distractor body with universal joint

BC distractor body

AB distractor body with universal joint

AB distractor body

A footplate B footplate

Distractor body (lead screw inside)

Activation hex


Rigid extension arm

Flexibleextension arm

Extension arms– Allow the point of activation to be moved away from the

distractor for easier access with the activation instrument– Can be placed intraorally or percutaneously– May be removed during the consolidation phase without a

surgical procedure (see page 28)– Rigid arms available in 20 mm, 40 mm, and 60 mm

lengths, flexible arms available in 30 mm, 40 mm and60 mm lengths

– Materials: Titanium alloy (Ti-6AI-7Nb), cobalt chromiumalloy (Co-20Cr-15W-10Ni) and silicone

Note: Allergic reactions may occur in patients previously sen-sitised to nickel.

BC distractor bodies– End-translating distractor bodies work with B-style and C-

style footplates– Both footplates are positioned at one end of the distractor.

When the distractor is activated, the B-style footplatetranslates down the distractor away from the C-style foot-plate, which remains stationary

– Footplates can be placed more posteriorly on the mandiblewith the distractor body initially positioned either anterioror posterior to the osteotomy, depending on the orienta-tion

– Available in 15 mm, 20 mm, 25 mm, 30 mm, 35 mm and40 mm lengths

Activation hex

C footplate B footplate Distractor body

Machinescrew

Synthes 33

Implants


04.315.000 2.7 mm Titanium Machine Screw, for CMFDistractor, 3 ea.

04.315.001 Removable End Cap, for CMF Distractor,2 ea.

AB Distractor Bodies, End Activated, for CMF Distractor, 2 ea.Length (mm)

04.315.003 15

04.315.004 20

04.315.005 25

04.315.006 30

BC Distractor Bodies, End Activated, for CMF Distractor, 2 ea.Length (mm)

04.315.023 15

04.315.024 20

04.315.025 25

04.315.026 30

04.315.027 35

04.315.028 40

AB Distractor Bodies, End Activated with U-Joint, for CMF Distractor, 2 ea.

Length (mm)

04.315.053 15

04.315.054 20

04.315.055 25

04.315.056 30

BC Distractor Bodies, End Activated with U-Joint, for CMF Distractor, 2 ea.

Length (mm)

04.315.063 15

04.315.064 20

04.315.065 25

04.315.066 30

04.315.067 35

04.315.068 40

Removable Extension Arms, rigid, 2 ea.Length (mm)

04.315.104 20

04.315.108 40

04.315.112 60

Removable Extension Arms, flexible, 2 ea.Length (mm)

04.315.125 30

04.315.127 40

04.315.132 60

1.0 mm Mandible Mesh Feet, for CMF Distractor, 3 ea.Style

04.315.201 A-Type

04.315.202 B-Type

04.315.203 C-Type

1.0 mm Mandible Cloverleaf Feet, for CMF Distractor, 3 ea.Style

04.315.211 A-Type

04.315.212 B-Type

04.315.213 C-Type


04.315.301 A-Type

04.315.302 B-Type

04.315.303 C-Type


04.315.311 A-Type

04.315.312 B-Type

04.315.313 C-Type


04.315.401 A-Type

04.315.402 B-Type

04.315.403 C-Type

Synthes 35


04.315.411 A-Type

04.315.412 B-Type

04.315.413 C-Type


04.315.501 A-Type

04.315.502 B-Type

04.315.503 C-Type


04.315.511 A-Type

04.315.512 B-Type

04.315.513 C-Type


All screws with PlusDrive recess.

1.0 mm Titanium Cortex Screws, self-tapping, 20 ea.Length (mm)

400.404 4

400.406 6

400.408 8

400.410 10

400.412 12

1.2 mm Titanium Emergency Screws, 4 ea.Length (mm)

400.464 4

400.466 6

400.468 8

400.470 10

400.472 12

1.3 mm Titanium Cortex Screws, self-drilling, 20 ea.Length (mm)

400.454 4

400.456 6

1.3 mm Titanium Cortex Screws, self-tappingLenghth (mm) Qty.

400.434 4 10

400.436 6 10

400.438 8 20

400.440 10 10

400.442 12 10

1.7 mm Titanium Emergency ScrewsLength (mm) Qty.

400.484 4 6

400.486 6 6

400.488 8 4

400.490 10 2

400.492 12 2

1.5 mm Titanium Cortex Screws, self-drillingLength (mm) Qty.

400.054 4 10

400.056 6 20

400.058 8 20

1.5 mm Titanium Cortex Screws, self-tappingLength (mm) Qty.

400.034 4 10

400.036 6 20

400.038 8 20

400.040 10 10

400.042 12 10


400.274 4 4

400.276 6 8

400.278 8 8

400.280 10 2

400.282 12 2

2.0 mm Titanium Cortex Screws, self-drillingLength (mm) Qty.

401.061 4 10

401.063 6 20

401.065 8 20

2.0 mm Titanium Cortex Screws, self-tappingLength (mm) Qty.

401.041 4 10

401.043 6 20

401.044 8 20

401.045 10 10

401.046 12 10

Screws

Synthes 37


401.791 5 4

401.792 6 12

401.794 8 12

401.795 10 4

401.796 12 4

2.0 mm Titanium Locking Screws, self-tappingLength (mm) Qty.

401.292 6 20

401.294 8 20

401.295 10 10

401.296 12 10


03.307.002 Silicone Tip Guard

03.315.001 Activation Instrument, 1.7 mm, for CMFDistractor

03.315.003 Alignment Rod, for CMF Distractor

03.315.004 Removal Instrument, for CMF Distractor(For attaching and removing extensionarms)

03.315.005 Activation Instrument, 1.7 mm withU-Joint, for CMF Distractor

Instruments

Synthes 39


03.500.014 Cutting Instrument, for DistractionFootplates

03.503.039 Plate Cutter for Midface Plates

Instruments


312.154 1.5 mm Threaded Drill Guide, long,for 2.0 mm plates

1.5 mm/2.0 mm Screwdriver Blades,self-retaining, PlusDrive, hex coupling

313.252 96 mm313.253 76 mm

Screwdriver Blades, self-retaining,PlusDrive, hex coupling

313.806 1.3 mm, 76 mm314.485 1.0 mm, 75 mm

Cruciform Screwdriver Blades withSpring Holding Sleeve, hex coupling

314.482 1.0 mm314.491 1.3 mm314.651 1.5 mm314.675 2.0 mm

0.76 mm Drill Bits, Stryker J-latch,for use with 1.0 mm screws

316.114 with 14 mm stop, 44.5 mm 316.150 with 5 mm stop, 44.5 mm 316.180 with 8 mm stop, 44.5 mm

311.006 Screwdriver Handle with hex coupling, medium

Synthes 41

347.964 Combination Bending Pliers,for 1.0 mm and 2.0 mm Plates


316.236 60 mm316.446 with 4 mm stop, 44.5 mm316.447 with 6 mm stop, 44.5 mm316.448 with 8 mm stop, 44.5 mm


317.140 with 4 mm stop, 44.5 mm317.160 with 6 mm stop, 44.5 mm317.180 with 8 mm stop, 44.5 mm317.220 with 12 mm stop, 44.5 mm316.500 80 mm


317.640 with 4 mm stop, 44.5 mm317.660 with 6 mm stop, 44.5 mm317.680 with 8 mm stop, 44.5 mm317.720 with 12 mm stop, 44.5 mm316.510 80 mm

319.520 Depth Gauge, long, for 1.5 mm and2.0 mm screws


347.980 Plate Holding Forceps, for 1.5 mm, 2.0 mmand 2.4 mm plates

Plate Holding Instruments347.986 for 1.0 mm and 1.3 mm plates347.987 for 1.5 mm and 2.0 mm plates

391.952 Cutter for Strut Plates and Mesh Plates

391.965 Combination Bending/Cutting Pliers,for 1.0 mm to 2.0 mm plates

Instruments

Synthes 43

397.213 2.0 mm Cannula and Obturator

397.232 Malleable C-Retractor

397.420 2.0 mm Cheek Retractor Blade

397.430 2.0 mm Cheek Retractor Ring

397.211 Universal Trocar Handle


CMF Distraction System Set(01.315.000)

Graphic Cases, Trays and Modules690.670 Graphic Case, for CMF Distractor690.625 Basic Craniofacial Tray Insert690.657 Orthognathic Trocar Tray Insert690.672 Distraction Instrument Insert Tray,

for CMF Distractor304.071 BC Distractor Body/Extension Arm Module,

for CMF Distractor304.072 1.0 mm/1.3 mm Mandible Module,

for CMF Distractor304.073 1.5 mm Mandible Module,

for CMF Distractor304.074 2.0 mm Mandible Module,

for CMF Distractor304.089 AB Distractor Body Module,

for CMF Distractor304.099 CMF Distractor Label Sheet

Screw Length MarkersScrew Length Markers, 1 pkg. of 10

304.104 4 mm304.106 6 mm304.108 8 mm304.110 10 mm304.112 12 mm

Screw Length Markers, for self-drillingscrews

304.104W 4 mm, 4 ea.304.106W 6 mm, 6 ea.304.108W 8 mm, 4 ea.

Izadi K, Yellon R, Mandell DL, et al. (2003) “Correction of Upper Air-way Obstruction in the Newborn with Internal Mandibular Distrac-tion Osteogenesis.” J Craniofac Surg 14:493-499.

Mandell DL, Yellon R, Bradley J, et al. (2004) “Mandibular Distrac-tion for Micrognathia and Severe Upper Airway Obstruction.” Arch Otolaryngol Head Neck Surg 130:344-348.

Steinbacher D, Kaban L, Troulis M. (2005) “Mandibular Advance-ment by Distraction Osteogenesis for Tracheostomy-Dependent Chil-dren with Severe Micrognathia.” J Oral Maxillofac Surg 63:1072-1079.

Bibliography

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Craniomaxillofacial (CMF) Distraction System. A modular family of ...

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