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Fariña et al.                                                                                                                                                           Skeletal anchorage for rigid external distractor

           means that the line of action of the force vector is direct   Financial support and sponsorship
           as there is no intermediary device to reduce the force.   None.
                                 [5]
           As Figueroa  and  Polley  discuss, the wire  splint  of
           RED I, which has an extraoral wire and traction hooks,   Conflicts of interest
           has some flexibility, which allows the distraction wire
           force to accumulate and then be liberated gradually. In   The  authors  have  no  commercial  or  financial
                                                              associations that might create a conflict of interest with
           other words, once the screw is activated, the distraction   the information presented in this manuscript.
           effect  is not immediate, but  as the  wire recovers its
           shape it  becomes  a  continuous tension. [3,11,19]   We   Patient consent
           believe the mechanism described by the authors  is
                                                       [5]
           not ideal because the wire undergoes elastic deformity   All patients signed an informed consent letter before
           that prevents the applied force from being transferred   participating in the study.
           in its entirety to the bone being distracted. [11,12]
                                                              Ethics approval
           SARED is  more  comfortable  than the  intraoral splint   This study was approved by ethical board of Hospital
           anchorage, because it  does  not  interfere with the   del Salvador.
           functions of the oral cavity. It  allows uninterrupted
           eating because there is no device, wires or splints   REFERENCES
           inside the mouth. Patients can, therefore, brush their
           teeth even when they have braces. In addition, patients   1.   Polley JW, Figueroa AA. Rigid external distraction: its application in
           with SARED can continue their orthodontic treatment   cleft maxillary deformities. Plast Reconstr Surg 1998;102:1360-72;
           during the whole distraction and consolidation period.   discussion 1373-4.
                                                              2.   Polley JW, Figueroa AA. Management of severe maxillary deficiency
                                                                 in childhood and adolescence through distraction osteogenesis with
           The percutaneous exits of the wires from the nasolabial   an external, adjustable, rigid distraction device.  J Craniofac Surg
           folds do not compromise  aesthetics  because  the     1997;8:181-5; discussion 186.
           scars are hidden in face wrinkles. Other authors have   3.   Molina F, Monasterio FO, de la Paz Aguilar M,  Barrera J. Maxillary
           previously suggested the  use of  percutaneous wires   distraction:  aesthetic  and  functional  benefits  in  cleft  lip-palate  and
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                                                                 1998;101:951-63.
           RED II and have reported no major complications. [18]  4.   Combs PD, Harshbarger RJ 3rd. Le fort I maxillary  advancement
                                                                 using distraction osteogenesis. Semin Plast Surg 2014;28:193-8.
           Finally, SARED does not require further surgery to be   5.   Figueroa  AA, Polley  JW.  Management  of  severe  cleft  maxillary
           removed, as do osteosynthesis anchored  devices. [11]    deficiency with distraction osteogenesis: procedure and results. Am J
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           anaesthetic on an outpatient basis. The use of SARED   6.   Burstein  F, Soldanska  M, Granger  M, Berhane  C,  Schoemann  M.
                                                                 Initial experience with a new intraoral midface distraction device. J
           simplifies a process that is highly complex itself and   Craniofac Surg 2015;26:1224-8.
           delivers better conditions for the patient and surgeon.   7.   Nishimoto S, Oyama T, Shimizu F, Tsugawa T, Nagashima T,
                                                                 Yamamoto  K, Kamiji  T, Kanomi  R. Fronto-facial  monobloc
           Using SARED is a convenient method to distract the    advancement  with  rigid  external  distraction  (RED-II) system.  J
           midface.  Advantages include better control of the    Craniofac Surg 2004;15:54-9.
           distraction vector and force when compared to the use   8.   Miyazaki H,  Katada H, Ichinokawa Y, Hirabayashi S, Sueishi K.
                                                                 Orthodontic treatment in combination with Le Fort II bone distraction
           of a dental anchorage (RED I) or a dental anchorage   in patient with Apert syndrome. Bull Tokyo Dent Coll 2013;54:9-17.
           with an osteosynthesis  plate anchorage  (RED II).    9.   Raposo-Amaral CE, Denadai R, Ghizoni E, Buzzo CL, Raposo-
           SARED improves patient comfort levels, oral hygiene   Amaral CA. Family of crouzon syndrome represents the evolution of
           and overall oral health. The method proposed is simple,   the frontofacial monobloc advancement technique: from immediate
           reduces costs and complications.                      movement to monobloc distraction to monobloc bipartition distraction.
                                                                 J Craniofac Surg 2015;26:1940-3.
                                                              10.  Nout E, Cesteleyn LL, van der Wal KG, van Adrichem LN, Mathijssen
           DECLARATIONS                                          IM, Wolvius EB. Advancement of the midface, from conventional Le
                                                                 Fort III osteotomy to Le Fort III distraction: review of the literature.
           Authors’ contributions                                Int J Oral Maxillofac Surg 2008;37:781-9.
           Concept,  design,  definition  of  intellectual  content,   11.  Baek SH, Seo YJ. Application  of orthodontic  mini-implants  and
           literature search, clinical studies, data acquisition, data   ligation for absolute skeletal anchorage to the intraoral labiolingual
                                                                 appliance:  midface  distraction  osteogenesis cases treated  with the
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            148                                                                                   Plastic and Aesthetic Research ¦ Volume 4 ¦ September 05, 2017
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