Distraction Osteogenesis in the Management of Severe Maxillary Hypoplasia in Cleft Lip and Palate Patients

Abstract

The aim of this study was to systematically review literature reporting on the use of external distraction osteogenesis (DO) and internal DO in the treatment of severe maxillary hypoplasia in cleft and palate patients. Literature research has been performed using the PubMed database of the National Library of Medicine and National Institutes of Health from 1966 to August 2007. We used cleft lip and palate and distraction osteogenesis as key words. Of the 104 articles found, we only considered the Anglo-Saxon literature, which reported on the correction of the maxillary hypoplasia with DO techniques. A total of 32 studies reported on anteroposterior external DO (27 studies on rigid external device and 5 on face mask), 17 studies reported on anteroposterior internal DO, and 3 studies reported on transverse internal DO have been retained for this review. Despite the heterogeneity and methodological limitations of most of the studies, results showed that external DO with rigid external device and internal DO resulted to be a more reliable and accurate technique than the face mask in the management of severe maxillary hypoplasia in patients with cleft lip and palate. The current review demonstrated that external and internal DO in the treatment of severe maxillary hypoplasia in cleft and palate patients (1) is a reproducible and valuable alternative to standard orthognathic surgery procedures, (2) allows for a global improvement in facial aesthetic, (3) allows a maxillary correction in patients during the period of mixed dentition, and (4) allows either for an unchanged or better velopharyngeal function.

Three-dimensional quantitative evaluation of midfacial skeletal changes after trans-sutural distraction osteogenesis for midfacial hypoplasia in growing patients with cleft lip and palate

“…Extensive morphologic studies have demonstrated these skeletal and/or dental deficiencies present in the anteroposterior (AP), vertical, and transverse dimensions in the early stages of pediatric growth ( € Oztürk and Cura, 1996;Schneiderman et al, 2009;Abuhijleh et al, 2014). Therefore, instead of waiting until skeletal maturity, midfacial hypoplasia have been early treated in growing patients because of psychological, functional, and esthetic concerns (Ho et al, 2006;Scolozzi, 2008).…”

“…The early treatment options for midfacial hypoplasia mainly include distraction osteogenesis (DO) with Le Fort osteotomy (Scolozzi, 2008) and trans-sutural distraction osteogenesis (TSDO) (Liu et al, 2005;Tong et al, 2015), which both progressively advance the skeleton in association with the expansion of the surrounding soft tissue. TSDO has been proved to have the advantage of achieving the advancement of midfacial skeleton by applying force to the immature circummaxillary sutures while successfully avoiding the risk of Le Fort osteotomy in some way, but there is still lack of recognition of the mechanism of the TSDO in growing CLP patients.…”

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

“…Ross et al (1989) showed that about 25% of patients with unilateral cleft lip and palate develop maxillary hypoplasia that does not respond to orthodontic treatment alone [3]. Moreover, as a result of the severe maxillary hypoplasia, the mandible often undergoes anterior and superior autorotation with subsequent overclosure of the vertical dimension, resulting in a loss of facial height, pseudoprognathism, and upward inclination of the occlusal plane [4].…”

Análise de recidiva após osteotomia Le Fort I para avanço maxilar em pacientes com fissura de lábio e palato

“…Mais de 25% desses indivíduos irão desenvolver uma significativa hipoplasia maxilar e fatalmente se submeterão a osteotomia maxilar, técnica mais utilizada para solucionar essa deficiência de crescimento. (THONGDEE et al, 2005;SCOLOZZI et al, 2008).…”

“…A possibilidade de uma recidiva cirúrgica é significativa, e poderá fazer com que o paciente retorne a uma condição estética e funcional desagradável (THONGDEE et al, 2005;SCOLOZZI et al, 2008).…”