Nasopharyngoscopic Analyses through Anterior Maxillary Distraction Osteogenesis for Adolescent Patients With Cleft Palate

Abstract

Anterior maxillary distraction osteogenesis (AMDO) is a novel technique for correcting hypoplastic maxilla by sagittal expansion of the maxilla. Recent reports suggest that AMDO does not have an effect on fragile velopharyngeal function in patients with cleft palate. Furthermore, no studies have evaluated the impact of AMDO on velopharyngeal function. We adopted AMDO to correct severe hypoplastic maxilla in adolescent patients with cleft palate and evaluated its impact on velopharyngeal space and function in 8 patients aged 12 to 21 years who underwent AMDO from 2006 to 2014. All the patients had received treatment for cleft palate; however, they still exhibited marginal velopharyngeal insufficiency. The mean activation of the distractor was 10.9 ± 0.9 mm. We determined changes in velopharyngeal closure ratio and closure pattern via nasopharyngoscopy. Additionally, skeletal changes were evaluated using lateral cephalograms. The mean horizontal advancement in the cephalogram obtained 1 year after the distraction was +6.4 mm. Nasopharyngoscopic examination revealed that no deterioration of velopharyngeal gap had occurred after AMDO in all 8 patients. The velopharyngeal closure pattern changed from coronal to circular in 1 patient. Our results indicate that AMDO achieved correction of hypoplastic maxilla without deterioration in velopharyngeal gap and function. Therefore, AMDO is an effective and optimal approach for correcting hypoplastic maxilla especially in patients with fragile velopharyngeal function, such as those with cleft palate.

Cleft Maxillary Hypoplasia: Comparison of Techniques and Proposal of a Novel Treatment Protocol for Management

“…[29][30][31] Some studies have also reported improvement in speech parameters and velopharyngeal closure following AMD. 9,28,32 Our findings are in accordance with these studies. This serves as one of the greatest merits of the procedure.…”

“…No signs of velopharyngeal morphologic changes or speech deterioration was noted even in patients with pre-existing VPI in the previous studies 29–31 . Some studies have also reported improvement in speech parameters and velopharyngeal closure following AMD 9,28,32 . Our findings are in accordance with these studies.…”

“…In cases of mild and moderate hypoplasias and irrespective of the presence or absence of VPI, AMD is the preferred treatment modality. The procedure can result in improved speech outcomes in this age group as observed in the present study as well as other studies 9,28,32 . At the same time, the authors feel that if the hypoplasia is less than 4 mm, the surgeon can choose to wait till the child progresses to the adult age group for carrying out a conventional Le fort I maxillary advancement surgery.…”

“…The procedure can result in improved speech outcomes in this age group as observed in the present study as well as other studies. 9,28,32 At the same time, the authors feel that if the hypoplasia is less than 4 mm, the surgeon can choose to wait till the child progresses to the adult age group for carrying out a conventional Le fort I maxillary advancement surgery. In the authors' view, subjecting the patients to intra-oral distractor until consolidation period which roughly corresponds to 3 months is not justified for discrepancy as less as 4 mm.…”

Effect of the maxillary bone expansion on the nasopharyngeal airway. A bibliographic review

“…Para funcionar como terapia REM la expansión se prescribe un cuarto de vuelta (0.25 mm), dos veces por día (5). Se realiza hasta que las cúspides palatinas de los primeros molares superiores entren en contacto con las cúspides bucales de los primeros molares inferiores (1,3,(5)(6)(7)(8). Hasta obtener en promedio 5 +-1 mm de expansión transversal en un lapso de 5.5+-1.0 meses (3,4,8).…”