American Journal of Orthodontics and Dentofacial Orthopedics
Management of severe cleft maxillary deficiency with distraction osteogenesis: Procedure and results☆,☆☆
Section snippets
Patient Selection and Evaluation
Patients were selected based on cause and severity of the maxillary hypoplasia. Presurgical records were obtained including a comprehensive speech evaluation by the speech and language pathologist. The cephalometric radiographs are obtained at the completion of distraction and at yearly intervals to monitor outcome. Time was spent with the patient and the patient’s family, explaining in detail the distraction process with photographs and video imaging, as well as discussion with other patients
CEPHALOMETRIC EVALUATION
The preoperative and postretention lateral cephalometric radiographs were used for analysis. The postretention radiographs were obtained 3 to 4 months after distraction. The radiographs were traced, and 13 anatomic landmarks were recorded (Fig 7).
RESULTS
All of the surgery and RED device placement in this series was performed by a single surgeon (JWP). Perioperative antibiotics were routinely used. All patients began routine oral hygiene and an unrestricted soft diet 24 hours postoperatively. No intermaxillary fixation nor bone grafts were used.
There was no surgical morbidity in any of the 14 patients in this series. There were no problems with bleeding or infection. None of the patients required a blood transfusion; there were no problems of
DISCUSSION
It has been estimated that 25% to 60% of all patients born with complete unilateral cleft lip and palate will require maxillary advancement to correct the maxillary hypoplasia and improve aesthetic facial proportions.11, 12 Patients with severe cleft maxillary deficiency are difficult to treat with standard surgical/orthodontic approaches. These patients have maxillary hypoplasia (vertical, horizontal, and transverse dimensions) and often thin or structurally weak bone. The hypoplasia in cleft
CONCLUSIONS
Maxillary distraction osteogenesis after complete osteotomy with the RED technique is a highly effective treatment modality to manage cleft-related maxillary hypoplasia. The technique allows for vector control of the osteotomized maxilla throughout the distraction process. It has been used, with minimal morbidity, in children as young as 5 years of age, adolescents, and adults. In all patients treated with RED the initial negative skeletal convexity and dental overjet were satisfactorily
Acknowledgements
We thank Dr. Eric Jein-Wein Liou for computer and statistical assistance.
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Cited by (145)
Cleft and Craniofacial Surgery
2023, Journal of Oral and Maxillofacial SurgeryVirtual planning and CAD/CAM-assisted distraction for maxillary hypoplasia in cleft lip and palate patients: Accuracy evaluation and clinical outcome
2021, Journal of Cranio-Maxillofacial SurgeryCitation Excerpt :Traditional Le Fort I osteotomy may correct the majority of cases (Meazzini et al., 2015; Iannetti et al., 2004); however, in the presence of severe maxillary hypoplasia requiring larger advancements, scarring from previous surgeries can limit the stretching of soft tissue and hinder mobilization of the maxilla, resulting in an insufficient forward repositioning of the maxilla and a high relapse rate (Stoelinga et al., 1987; Posnick et al., 1994; Cheung et al., 2006; Iannetti et al., 2004; Saltaji et al., 2012; Thongdee et al., 2005; Kanno et al., 2008; Jiang et al., 2020). In severe CLP midface hypoplasia, use of DO allows progressive bone elongation, with concomitant expansion of the soft tissue envelope, mitigating the retractile forces of the scar tissues, allowing larger movements and reducing the risk of relapse (Cohen et al., 1995; Molina et al., 1998; Figueroa et al., 1999, 2004; Swennen et al., 1999; Rachmiel et al., 2005; Cheung et al., 2006; Scolozzi, 2008; Jiang et al., 2020; Richardson et al., 2020). Both external rigid distractors and internal miniaturized distractors have been used.
Cleft Lip and Palate: Le Fort I Distraction Using an Internal Device
2021, Clinics in Plastic SurgeryA retrospective analysis of complications associated with tooth-borne anterior maxillary distraction for managing cleft maxillary hypoplasia: A 12-year experience
2020, Journal of Cranio-Maxillofacial SurgeryCitation Excerpt :This correlation indicated that a learning curve was involved and that, with increasing surgical experience, the procedure could be accomplished with a significantly decreased number of complications. Approximately 25%–47% of CLP patients presenting with maxillary hypoplasia require a surgical intervention (maxillary advancement in the form of conventional orthognathic surgery, total maxillary DO, or AMD) for achieving desirable aesthetic and functional results (Richardson et al., 2016b; Scolozzi, 2008; Polley and Figueroa, 1999; Good et al., 2007). AMD using a tooth-borne palatal distractor is a novel technique that is been increasingly used for correcting mild to moderate degrees of cleft maxillary hypoplasia, and it offers a number of advantages over conventional orthognathic surgery in terms of stable long-term results and improved if not unhampered speech outcomes (Richardson et al., 2016a, 2016b).
Cleft and Craniofacial Surgery
2017, Journal of Oral and Maxillofacial SurgeryDoes the Rigid External Distraction Device Alter Maxillary Pitch in Cleft Maxillary Distraction?
2023, Cleft Palate Craniofacial Journal
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Reprint requests to: Alvaro A. Figueroa, DDS, MS, Craniofacial Center, University of Illinois at Chicago, 811 S. Paulina St., Rm. 161 COD M/C 588, Chicago, IL 60612; E-mail, [email protected]
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