Discussion: Long-Term Skeletal Stability after Maxillary Advancement with Distraction Osteogenesis Using a Rigid External Distraction Device in Cleft Maxillary Deformities

Objective: To evaluate the changes in maxillary position after maxillary distraction osteogenesis in six growing children with cleft lip and palate. Design: Retrospective, longitudinal study on maxillary changes at A point, anterior nasal spine, posterior nasal spine, central incisor, and first molar. Setting: The University Hospital Craniofacial Center. Main Outcome Measure: Cephalometric radiographs were used to measure the maxillary position immediately after distraction, at 6 months, and more than 1 year after distraction. Results: After maxillary distraction with a rigid external distraction device, the maxilla (A point) on average moved forward 9.7 mm and downward 3.5 mm immediately after distraction, moved backward 0.9 mm and upward 2.0 mm after 6 months postoperatively, and then moved further backward 2.3 mm and downward 6.8 mm after more than 1 year from the predistraction position. Conclusion: In most cases, maxilla moved forward at distraction and started to move backward until 1 year after distraction, but remained forward, as compared with predistraction position. Maxilla also moved downward during distraction and upward in 6 months, but started descending in 1 year. There also was no further forward growth of the maxilla after distraction in growing children with clefts.

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One-Year Treatment Outcome of Profile Changes After Transcutaneous Maxillary Distraction Osteogenesis in Growing Children With Cleft Lip and Palate

The Cleft Palate-Craniofacial Journal ◽

10.1177/10556656211005638 ◽

2021 ◽

pp. 105566562110056

Author(s):

Wei-Ling Gao ◽

Yi-Hao Lee ◽

Chi-Yu Tsai ◽

Te-Ju Wu ◽

Jui-Pin Lai ◽

...

Keyword(s):

Treatment Outcome ◽

Distraction Osteogenesis ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Long Term Stability ◽

Maxillary Advancement ◽

Anterior Nasal Spine ◽

Profile Changes ◽

One Year

Objective: To evaluate the long-term stability of LeFort I osteotomy followed by distraction osteogenesis with a transcutaneous rigid external device for the treatment of severe maxillary hypoplasia in patients with cleft lip and palate. Patients and Methods: Nine patients with cleft lip and palate underwent rigid external distraction after a LeFort I osteotomy for maxillary advancement. Lateral cephalometric films were analyzed for assessment of treatment outcome and stability in 1 month, 6 months, and 1 year after distraction. Results: Significant maxillary advancement was observed in the horizontal direction, with the anterior nasal spine (ANS) distance of the maxilla increasing by an average of 20.5 ± 5.1 mm after distraction. The ANS relapse rates in 6 months and 1 year were 8.7% and 12.8%, respectively. The mean inclination of upper incisors to the palatal plane was almost unchanged (before: 109.8° ± 6.6°; after: 108.9° ± 7.5°). The movement ratios at the nasal tip/ANS, soft tissue A point/A point, and the upper vermilion border/upper incisor edge were 0.36:1, 0.72:1, and 0.83:1, respectively. Conclusion: Considerable maxillary advancement was achieved with less change of incisors inclination after distraction. Moreover, the relapse rate after 1 year was minimal. The concave facial profile was improved as well as the facial balance and aesthetics.

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