Maxillary Advancement With Internal Distraction Device in Cleft Palate Patients

Abstract

This study aimed to evaluate the results of maxillary advancement by using internal Le Fort 1 distractors on six patients with unilateral cleft lip and palate who had maxillary hypoplasia. The retrognathic maxilla of five patients were protracted with distractor bilaterally, and asymmetric advancement was performed in one patients. A removable intraoral acrylic appliance was used as an anchorage appliance in two patients, and Ragno fan-type expander appliance was used in the others to prevent maxillary collapse during the distraction period. The maxilla of one patient was not distracted successfully due to the maxillary collapse in result of breaking the removable anchorage appliance away. Lateral cephalograms were evaluated before 3 and 12 months after distraction.A desired level of advancement was attained in five patients. In one patient distraction was not performed due to the maxillary collapse. In one of the five patients with a wide oronasal fistula, the size of the fistula was decreased with asymmetric advancement of right and left maxillary segments. Following the retention period of 12 months, the results were stable. It was concluded that effective and easy distraction is possible with internal Le Fort 1 distractors in cleft lip and palate patients who requires maxillary advancement.

Systematic review and meta-analysis: Mandibular plane change after orthognathic surgery and distraction osteogenesis in cleft lip and palate patients

“…For IDO, all three papers in our study showed increased SN-MP at post-treatment ranging from 28 to 3.78 [17,21,24]. However, it should be noted that standard deviation of mean SN-MP in IDO were highly varied among the three papers.…”

“…However, inconsistent change of SN-MP after IDO and were reported [17,23,24]. For mandibular plane relapse, the results also showed large variation of relapse [17,21,24].…”

“…Twelve papers were finally selected for further quantitative meta-analysis, which could be classified as followed; (1) conventional orthognathic surgery (CO: n = 4) [30][31][32][33], (2) extraoral distraction osteogenesis (EDO: n = 5) [13][14][15]34,35] and (3) intraoral distraction osteogenesis (IDO: n = 3) [17,21,24]. Characteristics of selected studies are presented in Table 1.…”

“…Interestingly, inconsistent change of SN-MP after follow-up was reported. Rachmiel et al [23] reported slight decrease of SN-MP from 34.588 at postdistraction to 34.438 at 1 year follow-up while Gulsen et al [24] showed SN-MP decreased greater than 28 after distraction in four out of five patients. However, Gateno et al [17] in their three case reports, two cases had increased SN-MP at follow-up.…”

Maxillary Movement in Cleft Patients Treated with Internal Tooth Borne Distractor

“…These include: The ease of anchoring the appliance and the ease of adaptation to the appliance by the patient especially during the consolidation phase is significant. Distraction osteogenesis with internal devices reduces the physical and psychological stress on the patient caused by the external devices [9].…”