Stability of maxillary advancement using external rigid distractors in cleft lip and palate patients

Sondos Abuzinada, Ahmed Alyamani

Department of Oral and Maxillofacial Surgery, King Abdulaziz University, Jeddah, KSA.

DOI: 10.4236/ojst.2012.24066                

Abstract

Purpose: To evaluate the skeletal changes associated with maxillary advancement using the external rigid distractor in cleft lip and palate patients after distraction and to assess the stability of these changes. Patients and Methods: Eight cleft lip and palate patients with maxillary hypoplasia underwent maxillary distraction osteogenesis using external rigid devise. Lateral cephalometric records were obtained before distraction T1 and after completing active distraction T2. After a three month follow up period a final lateral cephalometric record was evaluated T3. Results: The maxilla was significantly advanced as indicated by the increase in maxillary depth angle and effective maxillary length (median difference, 10 mm). The palatal plane angle showed a significant increase (median difference, 5o), showing clockwise rotation. At T3 there was a slight decrease in maxillary depth angle (median difference, 3o). Effective maxillary length decreased significantly at T3 (median difference, 2 mm). The palatal plane angle decreased (median difference, 3o) and almost returned to its original position, showing a counterclockwise rotation. Conclusion: Maxillary advancement using external rigid distractor resulted in clockwise rotation of maxilla with increase in palatal plane angle and slight increase in mandibular plane angle. The amount of maxillary advancement was slightly reduced during follow up and the palatal plane almost returned to its original position. These changes showed good stable clinical results.

Keywords

Maxillary Hypoplasia; Cleft Lip; Palate; Maxillary Distraction Osteogenesis

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Panula, K., Lorius, B. and Popisil, O. (1993) The need for orthognathic surgery in patients born with complete cleft palate or complete unilateral cleft lip and palate. Oral Surgery, Oral Diagnosis, 4, 23.
[2]	Rachmiel, A. (2007) Treatment of maxillary cleft palate: Distraction osteogenesis versus orthognathic surgery— Part one: Maxillary distraction. Journal of Oral and Maxillofacial Surgery, 65, 753-757. doi:10.1016/j.joms.2006.08.010
[3]	Ross, R. (1987) Treatment variables affecting facial growth in complete unilateral cleft lip and palate: An overview of treatment and facial growth. Cleft Palate- Craniofacial Journal, 24, 71-77.
[4]	Scolozzi, P. (2008) Distraction Osteogenesis in the management of severe maxillary hypoplasia in cleft lip and palate patients. Journal of Craniofacial Surgery, 19, 1199-1214. doi:10.1097/SCS.0b013e318184365d
[5]	Stoelinga, P.J.W., vd Vijver, R.M., Leenen, R.J., et al. (1987) The prevention of relapse after maxillary osteotomies in cleft palate patients. Journal of Cranio-Maxillofacial Surgery, 15, 326-331. doi:10.1016/S1010-5182(87)80078-1
[6]	Adlam, D. and Banks, P. (1989) A retrospective study of the stability of midface osteotomies in cleft lip and palate patients. British Journal of Oral and Maxillofacial Surgery, 27, 265-276. doi:10.1016/0266-4356(89)90037-5
[7]	Hirano, A. and Suzuki, H. (2001) Factors related to relapse after Le Fort Imaxillary advancement osteotomy in pateints with cleft lip and palate. Cleft Palate-Craniofacial Journal, 38, 1-10. doi:10.1597/1545-1569(2001)038<0001:FRTRAL>2.0.CO;2
[8]	Figueroa, A., Polley, J. and Ko, E. (1999) Maxillary distraction for the management of cleft maxillary hypoplasia with rigid external distraction system. Seminars in Orthodontics, 5, 46-51. doi:10.1016/S1073-8746(99)80042-5
[9]	Rachmiel, A., Aizenbud, D., Ardekian, L., et al. (1999) Surgically-assisted orthopedic protraction of the maxilla in cleft lip and palat patients. International Journal of Oral and Maxillofacial Surgery, 28, 9-14. doi:10.1016/S0901-5027(99)80668-7
[10]	Wiltfang, J., Hirschfelder, U., Neukam, F. and Kessler, P. (2002) Long-term results of distraction osteogenesis of the maxilla and midface. British Journal of Oral and Maxillofacial Surgery, 40, 473-479. doi:10.1016/S0266435602002474
[11]	Figueroa, A., Polley, J., Friede, H. and Ko, E.W. (2004) Long-term skeletal stability after maxillary advancement with distraction osteogenesis using a rigid external distraction device in cleft maxillary deformities. Plastic and Reconstructive Surgery, 114, 1382-1393.
[12]	Rachmiel, A., Aizenbud, D. and Peled, M. (2005) Long term results in maxillary deficiency using intraoral devices. International Journal of Oral and Maxillofacial Surgery, 34, 473-479. doi:10.1016/j.ijom.2005.01.004
[13]	Harada, K., Sato, M. and Omura, K. (2005) Long-term skeletal and dental changes in patients with cleft lip and palate after maxillary distraction: A report of three cases treated with a rigid external distraction device. Cranio, 23, 152-157.
[14]	Ricketts, R.M., Bench, R.W., Gugino, C.F., et al. (1980) Bioprogressive therapy. Rocky Mountain Orthodontics, Denver.
[15]	Cheung, L. and Chua, H. (2006) A meta-analysis of cleft maxillary osteotomy and distraction osteogenesis. International Journal of Oral and Maxillofacial Surgery, 35, 14-24. doi:10.1016/j.ijom.2005.06.008
[16]	Ochoa, B. and Nanda, R. (2004) Comparison of maxillary and mandibular growth. American Journal of Orthodontics & Dentofacial Orthopedics, 125, 148-159. doi:10.1016/j.ajodo.2003.03.008
[17]	Precious, D. (2007) Treatment of retruded maxilla in cleft lip and palate—Orthognathic surgery versus distraction osteogenesis: The case for orthognathic surgery. Journal of Oral and Maxillofacial Surgery, 65, 758-761. doi:10.1016/j.joms.2006.08.011
[18]	Kanno, T., Mitsugi, M., Hosoe, M., Sukegawa, S., et al. (2008) Long-term skeletal stability after maxillary advancement with distraction osteogenesis in non-growing patients. Journal of Oral and Maxillofacial Surgery, 66, 1833-1846. doi:10.1016/j.joms.2007.10.013
[19]	Wang, X., Yi, B., et al. (2005) Internal midface distraction in correction of severe maxillary hypoplasia secondary to cleft lip and palate. Plastic and Reconstructive Surgery, 116, 51-60. doi:10.1097/01.PRS.0000169691.22783.29
[20]	Harada, K., Baba, Y., Ohyama, K., et al. (2001) Maxillary distraction osteogenesis for cleft lip and palate children using an external, adjustable, rigid distraction device: A report of 2 cases. Journal of Oral and Maxillofacial Surgery, 59, 1492-1496. doi:10.1053/joms.2001.28292
[21]	Aksu, M., Saglam, B., Akcan, C., et al. (2010) Skeletal and dental stability after maxillary distraction with a rigid external device in adult cleft lip and palate patients. Journal of Oral and Maxillofacial Surgery, 68, 254-259. doi:10.1016/j.joms.2009.03.030
[22]	Kusnoto, B., Figueroa, A. and Polley, J. (2001) Radiographic evaluation of bone formation in the pterygoid region after maxillary distraction with a rigid external distraction (RED) device. Journal of Craniofacial Surgery, 12, 109-117. doi:10.1097/00001665-200103000-00003