Histomorphometric Analysis of the Porcine Mandibular Distraction Wound

Purpose To analyze the sequence of histomorphometric changes in the regenerate during distraction osteogenesis (DO) of the minipig mandible. Materials and Methods A total of 16 minipigs underwent unilateral mandibular DO using a protocol of 0-day latency and a 1-mm/day rate for 12 days, and 24 days of fixation. The mandibles were harvested at mid-DO, end-DO, mid-fixation, and end-fixation. An additional 2 minipigs underwent acute lengthening, and 1 sham control was included. Serial gross examinations and plain radiographs were performed before paraffin embedding. The sections were stained with hematoxylin-eosin or hematoxylin/alcian blue/sirius red stain. Histomorphometric analysis was performed to determine the percentage of surface area (PSA) occupied by hematoma, fibrous tissue, cartilage, and bone. Results All 19 minipigs survived the operation, and 17 survived the observation period; 2 were killed because of infection (mid-DO, n = 1 and end-fixation, n = 1). No device failures occurred. Of the 17 specimens, 4 were at mid-DO, 4 at end-DO, 4 at mid-fixation, and 2 at end-fixation; 2 were in the acute lengthening group, and 1 was the sham control. Hematoma was present only at mid-DO (16.61 ± 8.07 PSA) and end-DO (1.17 ± 2.33 PSA). Fibrous tissue decreased from mid-DO (53.12 ± 8.59 PSA) to end-fixation (25.00 ± 0.83 PSA). Cartilage was present in end-DO (1.72 ± 2.71 PSA), mid-fixation (5.82 ± 6.64 PSA), and acute lengthening (1.43 ± 0.95 PSA). Bone increased from mid-DO (25.18 ± 0.99 PSA) to end-fixation (64.89 ± 0.79 PSA) and occurred earlier in the superior and middle thirds of the wounds. Periosteal bone formation predominated over endosteal bone formation early in distraction. Conclusion The results of the present study indicate that bone formation in this model consists of both intramembranous and endochondral components, with intramembranous osteogenesis predominating. Bone formation occurred earlier in the superior/middle portions of the wound, possibly owing to osteoinductive properties of developing tooth buds and the inferior alveolar nerve, respectively.