Abstract
Maxillary hypoplasia is a common outcome in patients with cleft lip and palate after
surgical and orthodontic interventions, and maxillary distraction osteogenesis has
become a useful procedure for patients with extensive maxillary deformities. The aim
of this study was to evaluate long term (two years) stability after maxillary advancement
of more than 10 mm by distraction osteogenesis in cleft patients using internal devices. We organised
a retrospective study on 42 patients with cleft lip and palate using cephalometric
analysis before and after maxillary distraction osteogenesis and evaluated them for
24 months. Postoperative measurements showed a marked advancement with an increase
of 13.3 mm and 10.8° in the length of the maxilla (Co-A) and SNA, respectively, including
a shift from Angle class III to class I in dental relations. Follow-up observations
showed preservation of maxillary length with a relapse of only 6.0 % (mean (SD) 0.8
(0.7) mm) and 10% relapse in SNA angle (mean (SD)1.1 (1.4) °) one year postoperatively
and a negligible regression at the two years’ follow up. This large-scale study shows
stable results of skeletal advancement using distraction osteogenesis, indicating
safe and reliable outcomes among patients with cleft lip and palate.
Keywords
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References
- Long-term effects of clefts on craniofacial morphology in patients with unilateral cleft lip and palate.Cleft Palate Craniofac J. 2005; 42: 601-609
- Cleft lip and palate surgery: an update of clinical outcomes for primary repair.Oral Maxillofac Surg Clin North Am. 2010; 22: 43-58
- Two-flap palatoplasty: 20-year experience and evolution of surgical technique.Plast Reconstr Surg. 2006; 118: 193-204
- Treatment of maxillary cleft palate: distraction osteogenesis versus orthognathic surgery–part one: Maxillary distraction.J Oral Maxillofac Surg. 2007; 65: 753-757
- Treatment of maxillary cleft palate: Distraction osteogenesis vs. orthognathic surgery.Ann Maxillofac Surg. 2012; 2: 127-130
- Le Fort I maxillary advancement using distraction osteogenesis.Semin Plast Surg. 2014; 28: 193-198
- Rigid external distraction: its application in cleft maxillary deformities.Plast Reconstr Surg. 1998; 102: 1360-1374
- Comparison of treatment outcome and stability between distraction osteogenesis and LeFort I osteotomy in cleft patients with maxillary hypoplasia.J Craniofac Surg. 2007; 18: 1209-1215
- Stability after cleft maxillary distraction osteogenesis or conventional orthognathic surgery.J Oral Maxillofac Res. 2015; 6: e2
- Cleft maxillary distraction versus orthognathic surgery: clinical morbidities and surgical relapse.Plast Reconstr Surg. 2006; 118: 996-1009
- Changes in speech following maxillary distraction osteogenesis.Cleft Palate Craniofac J. 2001; 38: 199-205
- Effect of maxillary distraction osteogenesis on velopharyngeal function: a pilot study.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002; 93: 538-543
- A meta-analysis of cleft maxillary osteotomy and distraction osteogenesis.Int J Oral Maxillofac Surg. 2006; 35: 14-24
- Management of cleft maxillary hypoplasia with anterior maxillary distraction: our experience.J Maxillofac Oral Surg. 2014; 13: 550-555
- Long-term results in maxillary deficiency using intraoral devices.Int J Oral Maxillofac Surg. 2005; 34: 473-479
- The tension-stress effect on the genesis and growth of tissues. Part I. The influence of stability of fixation and soft-tissue preservation.Clin Orthop Relat Res. 1989; 238: 249-281
- Midface advancement by gradual distraction.Br J Plast Surg. 1993; 46: 201-207
- Radiographic evaluation of bone formation in the pterygoid region after maxillary distraction with a rigid external distraction (RED) device.J Craniofac Surg. 2001; 12: 109-118
- Long-term skeletal stability after maxillary advancement with distraction osteogenesis using a rigid external distraction device in cleft maxillary deformities.Plast Reconstr Surg. 2004; 114: 1382-1394
- Skeletal stability and relapse patterns after Le Fort I maxillary osteotomy fixed with miniplates: the unilateral cleft lip and palate deformity.Plast Reconstr Surg. 1994; 94: 924-932
- Cleft maxillary distraction versus orthognathic surgery--which one is more stable in 5 years?.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010; 109: 803-814
- Long-term results of segmental repositioning of the maxilla in cleft palate patients without previously grafted alveolo-palatal clefts.J Craniomaxillofac Surg. 1996; 24: 109-117
- Soft tissue profile changes after maxillary advancement with distraction osteogenesis by use of a rigid external distraction device: a 1-year follow-up.J Oral Maxillofac Surg. 2000; 58: 959-970
- Long-term skeletal stability after maxillary advancement with distraction osteogenesis in cleft lip and palate patients.Angle Orthod. 2012; 82: 1115-1122
- Clinical controversies in oral and maxillofacial surgery: Part two. External versus internal distraction osteogenesis for the management of severe maxillary hypoplasia: external distraction.J Oral Maxillofac Surg. 2008; 66: 2598-2604
- Long-term results of maxillary distraction osteogenesis in nongrowing cleft: 5-years experience using internal device.Bratisl Lek Listy. 2016; 117: 685-690
- Skeletal and soft tissue changes and stability in cleft lip and palate patients after distraction osteogenesis using a new intraoral maxillary device.J Craniomaxillofac Surg. 2015; 43: 323-328
- Long-term follow-up of large maxillary advancements with distraction osteogenesis in growing and non-growing cleft lip and palate patients.J Plast Reconstr Aesthet Surg. 2015; 68: 79-86
- Distraction osteogenesis in maxillary deficiency using a rigid external distraction device.Plast Reconstr Surg. 2006; 117: 2399-2406
Article info
Publication history
Published online: May 18, 2020
Accepted:
March 25,
2020
Identification
Copyright
© 2020 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
