Long-term maxillomandibular skeletal and dental changes in children with cleft lip and palate after maxillary distraction

doi:10.1016/j.tripleo.2005.09.019

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology

Volume 102, Issue 3, September 2006, Pages 292-299

https://doi.org/10.1016/j.tripleo.2005.09.019 Get rights and content

Long-term skeletal and dental changes were examined in 8 children with cleft lip and palate who underwent maxillary distraction to allow the maxilla to catch up to their mandibular growth at the treatment point. Changes in the overjet (OJ), overbite (OB), and positions of the anterior nasal spine (ANS), upper incisors (U1), pogonion (Pog), and lower incisors (L1) were measured on preoperative to 36 months postoperative lateral-cephalograms. In most of the children, the long-term changes after the maxillary distraction resulted in an inferior growth of the maxilla and anteroinferior growth of the mandible. This seems to suggest that maxillary distraction performed during childhood needs considerable overcorrection. However, if the maxilla is distracted to an adult position during childhood, the masticatory functions of the children will markedly deteriorate until their jaws grow. Therefore, we believe that one goal of maxillary distraction during childhood can be to allow the maxilla to catch up to the mandibular growth of the children at the treatment point.

Section snippets

Subjects

A list of the individual children examined in this study is shown in Table I. We examined 8 children with cleft lip and palate who underwent maxillary distraction osteogenesis using the rigid external distraction device (Rigid External Distraction [RED] System; KLS-MARTIN LP, Tuttlingen, Germany) designed and initially reported by Polley and Figueroa.11, 12 These children consisted of 4 boys and 4 girls (mean age, 12.2 years; range, 9.5 to 14.1 years) diagnosed with complete unilateral cleft

Results

Fig. 2 shows the postoperative changes of ANS in the 8 children. The maxillary distraction resulted in a marked increase of the x-axis value for ANS in all the children. The mean increase in the x-axis values for ANS (maxillary advancement) was 10.1 mm (range, 6.0 to 14.6 mm). However, these values decreased in most of the children during the period from the removal of the device up to 6 months postoperatively, dropping to about 88% of the original increase obtained. From 6 to 36 months after

Discussion

In most of the children in this study, the ANS and U1 tended to change inferiorly, the Pog and L1 tended to change anteroinferiorly, and the OJ and OB tended to decrease gradually over the long term after maxillary distraction. In addition, the inferior change of the Pog and L1 was larger than that of the ANS and U1. This suggests that the long-term changes observed after the maxillary distraction in the children resulted from the inferior growth of the maxilla and anteroinferior growth of the

Conclusion

In summary, we reported long-term maxillomandibular skeletal and dental changes in 8 children with cleft lip and palate who underwent maxillary distraction using the RED system. Though anteroinferior growth of the mandible was observed over the long term after the maxillary distraction, we believe that maxillary distraction during childhood can be to allow the maxilla to catch up to the mandibular growth at the treatment point. However, overcorrection for the relapse (about 12% of the original

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Cited by (28)

Maxillary distraction with internal devices in cleft patients: Virtual planing and transference of dates to surgical field
2017, Revista Espanola de Cirugia Oral y Maxilofacial
Los dispositivos internos de distracción maxilar han sido poco utilizados debido a la dificultad que supone su colocación precisa. Esto se debe a que pequeñas imprecisiones en su orientación dan lugar a grandes imprecisiones en la posición final del hueso distraído. En este sentido, la cirugía asistida por ordenador es una herramienta de gran ayuda para alcanzar la máxima precisión. El objetivo de este trabajo es presentar nuestro protocolo de planificación de la posición de distractores internos, así como un nuevo objeto CAD/CAM para transferir los datos al campo quirúrgico.
Se planifica de forma virtual el avance maxilar de 2 pacientes fisurados y los vectores de movimiento virtual. Para la transferencia de datos al campo quirúrgico se utiliza una férula especial con acoples laterales que orientan el vector de distracción.
Dos pacientes fueron intervenidos con resultados satisfactorios.
Tanto el protocolo de planificación virtual del vector de distracción como el objeto CAD/CAM para transferencia de datos al campo quirúrgico presentado son útiles para aumentar la precisión en la posición final del maxilar. De esta forma el uso de distractores internos para avances menores de 12 mm resulta una técnica predecible.
Maxillary internal distractors have not been widely used since the accurate positioning is challenging. This is because a small deviation in the positioning results in a great deviation in the final position of the distracted maxilla. Computer assisted surgery is a powerful tool to reach accurate results. The authors report a protocol for internal distractor positioning as well as a new object for transferring dates from virtual planning to surgical field.
Virtual planning was performed to plan the maxillary advance in 2 cleft patients. A wafer with 2 lateral attachments was used to transfer the vector of distraction from virtual planning to surgical field.
Satisfactory result was achieved in both patients.
This virtual planning protocol as well as the CAD/CAM objet to transfer dates from computer to surgical field are useful in order to achieve a suitable final position of the maxilla. These tools facilitate the positioning of internal distractors, leaving the use of external distractors for advancement greater than 12 mm.
Maxillary distraction osteogenesis for treatment of cleft lip and palate in a patient with X-linked agammaglobulinemia
2014, Journal of Oral and Maxillofacial Surgery
X-linked agammaglobulinemia (XLA) is a congenital immune deficiency disorder caused by abnormal antibody production. It is a rare disease with an estimated frequency of 1 in 379,000 that has X-linked recessive heredity and develops only in males. The clinical problems include bacterial infection such as otitis media, sinusitis, and bronchitis. In recent years it has become possible to diagnose XLA in the early stage and intravenous immunoglobulin replacement therapy has permitted survival to adulthood. However, there have been no reports of oral surgery in patients with XLA. Here, we describe a case in which immunoglobulin replacement therapy given pre- and postoperatively was used to control infection in oral surgery and maxillary distraction osteogenesis performed for improving occlusion and appearance of a cleft lip and palate in a patient with XLA.
Maxillary advancement in cleft palate patients with intraoral distraction
2013, Revista Espanola de Cirugia Oral y Maxilofacial
Los pacientes fisurados labio palatinos presentan con frecuencia hipoplasia maxilar. La osteogénesis por distracción (DO) de maxilar superior es una técnica alternativa para pacientes con hipoplasia maxilar severa. Se han evaluado los cambios producidos en tejidos duros y blandos y su estabilidad en el tiempo.
Se ha realizado DO de maxilar a 6 pacientes (5 mujeres y un hombre) fisurados labio palatinos, entre 16-25 años, con un distractor interno. Hemos evaluado mediante trazados cefalométricos en radiografías y fotografías los cambios esqueléticos y en tejidos blandos. El tiempo de seguimiento fue entre 2-8 años.
En 5 pacientes el punto A avanza entre 3-10 mm mejorando significativamente las relaciones maxilo-mandibulares. En un paciente fracasa la DO intraoral y se termina el caso con RED; en un paciente se evidencia poco avance y rotación maxilar. La recidiva observada entre 6-9 meses post DO es entre el 10 y el 15% tanto esquelética como en tejidos blandos.
La DO intraoral es una técnica alternativa exitosa para avance del maxilar en pacientes fisurados labio palatinos que necesiten un avance inferior a 10 mm. Produce mejoras en el perfil esquelético y blando. Los dispositivos internos no producen impacto psicológico. La contención más larga en el tiempo. La recidiva es difícil de definir y calcular.
Patients with cleft lip and palate usually present with maxillary hypoplasia. Upper jaw intraoral distraction osteogenesis (DO) is an alternative technique for patients with severe maxillary hypoplasia. An evaluation was made of the changes produced in hard and soft tissues and their stability over time.
Six patients (5 female and 1 male) between 16 and 25 years old with cleft lip and palate underwent maxillary DO with an internal distractor. An evaluation was made of the skeletal and soft tissues changes using cephalometric studies with radiographs and photographs. Follow-up time was between 2 and 8 years.
There was Point A advancement between 3-10 mm in 5 patients, significantly improving maxillomandibular relationships. Intraoral DO failed in one patient, and the case was finished using rigid external distraction (RED). In another patient hardly any advancement and maxillary rotation was observed. The relapse observed between 6 and 9 months post DO was between 10-15% in both skeletal and soft tissues.
Intraoral DO is a successful alternative technique in maxillary advancement in patients with cleft lip and palate who need an advancement less than 10 mm. It produces improvements in the skeletal and soft profile. Internal devices do not have any psychological impact and have longer consolidation phases. Relapse is difficult to determine and calculate.
Effects of growth on maxillary distraction osteogenesis in cleft lip and palate
2013, Journal of Cranio-Maxillofacial Surgery
Citation Excerpt :
Harada et al. (2006) examined 8 children with CLP who underwent maxillary external distraction, with a follow-up of 36 months, and reported a relapse of 12% of the original maxillary advancement. The maxilla also showed an inferior growth during the follow-up period (Harada et al., 2006). They reported that maxillary distraction performed during childhood needed considerable overcorrection, but that the maxilla should not be distracted to an adult position to avoid marked deterioration of their masticatory function (Harada et al., 2006).
The objective was to analyze the effects of growth on the long-term result of maxillary distraction osteogenesis (DO) in cleft lip and palate (CLP).
Retrospective study of 24 CLP cases with long-term follow-up operated for maxillary DO using the Polley and Figueroa technique: 10 patients were distracted during growth, while 14 patients were operated after their growth spurt. Preoperative (T0), 6–12 months postoperative (T1), and ≥4 years postoperative (T2) cephalometric radiographs were evaluated. A classical cephalometric analysis was used to assess the treatment stability, and a Procrustes superimposition method was performed to assess local changes in the maxilla and the mandible.
At T0, the mean age was of 11.9 ± 1.4 years for growing patient, and 17.9 ± 3.5 years for patient treated after their growth spurt (P < 0.001). Between T0 and T1, a greater increase of the SNA was shown in growing patients (P = 0.036), but the relapse was more important between T1 and T2, with a significant decrease of the SNA (P = 0.002) and ANB (P = 0.032) compared to the patients treated after their growth spurt. Although not significant, growing patients showed greater rotations of their palatal plane and mandibular plane.
Maxillary DO in CLP does not correct the growth deficit inherent to the pathology. Overcorrection of at least 20% is advised during growth.
Cleft-Orthognathic Surgery: The Bilateral Cleft Lip and Palate Deformity
2013, Orthognathic Surgery: Principles and Practice
Cleft-Orthognathic Surgery: The Unilateral Cleft Lip and Palate Deformity
2013, Orthognathic Surgery: Principles and Practice

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Oral and maxillofacial surgeryLong-term maxillomandibular skeletal and dental changes in children with cleft lip and palate after maxillary distraction

Section snippets

Subjects

Results

Discussion

Conclusion

J Craniomaxillofac Surg

Br J Oral Maxillofac Surg

Int J Oral Maxillofac Surg

Am J Orthod Dentofac Orthop

J Oral Maxillofac Surg

J Craniomaxillofac Surg

Am J Orthod Dentofacial Orthop

On the means of lengthening in the lower limbs, muscles and tissues which are shortened through deformity

Am J Orthop Surg

Oral and maxillofacial surgery
Long-term maxillomandibular skeletal and dental changes in children with cleft lip and palate after maxillary distraction