Maxillary Movement in Cleft Patients Treated with Internal Tooth Borne Distractor

Abstract

Cleft lip and palate is associated with maxillary hypoplasia and retrognathism. Surgery and distraction have been the most common treatment approaches used. The aim of this study was to objectively assess the quantum and direction of movement of the anterior maxilla in cleft patients treated with an internal tooth borne distractor. A prospective clinical study design was followed in which 8 consecutive patients with cleft maxillary hypoplasia were included in the age range of 15-25 years. All patients had undergone secondary alveolar bone grafting earlier. Anterior maxillary distraction was performed using a tooth borne appliance in all 8 patients after necessary osteotomy. Lateral cephalograms were obtained preoperatively, predistraction and postdistraction. The angular and linear change at the maxillary anterior segment, rotation of the palatal plane, mandibular plane, increase in lower facial height and vertical changes of the anterior and posterior dentoalveolar segments were measured. The movement of the anterior maxillary segment was demonstrated anteriorly and superiorly in all the patients. The anterior and posterior dentoalveolar heights were increased post-distraction. There was also an increase in lower anterior facial height and the mandibular plane angle. Predictable superior and anterior movement of the anterior maxilla along with significant increase in palatal length could be achieved with the internal tooth borne distractor leading to remarkable improvement in esthetics and better function.

Photometric Evaluation of Soft Tissue Changes in CLP Patients: Le Fort I Advancement Osteotomy (ALO) Versus Anterior Maxillary Distraction (AMD)

“…The molar tipping and extrusion can be prevented by reinforcing the anchorage (including both the 1st and 2nd molars). Though incisor visibility improved invariably, upper lip length did not vary in both groups which is in correlation with the findings of Sunitha et al [31].…”

“…But the upward movement of nasal spine is more pronounced in ALO group since the maxilla is moved on an inclined plane during ALO [30]. Nasal widening was predominant with conventional Le Fort I maxillary advancement even though alar cinch suturing and V-Y closure have been done [31]. Lesser upward movement of subnasale may be the reason for mild alar base widening in AMD in contrast to ALO group.…”

“…Presently distraction osteogenesis (AMD) has become a mainstream surgical technique in treatment of jaw deficiencies [10]. Published cephalometric post treatment results in series of case reports and research papers have proved AMD to produce better results than conventional Le Fort I surgery [1,[28][29][30][31][32][33][34]. In the present study routine frontal and profile photographs were analysed to compare the soft tissue changes in both ALO and AMD.…”

Perpendicular serial maxillary distraction osteogenesis in cleft lip and palate patients

“…While external devices are used in certain cases, those in favor of internal devices point out that such devices can be worn out of plain sight and have minimal impact on the daily activities of the patient. [ 36 37 ] From a patient perspective, internal devices are preferred although reports indicate that there is a transient drop in self-esteem even with internal distractor wear. The self-esteem improves following distractor removal.…”

Dudak damak yarıklı hastalarda alveoler distraksiyon osteogenez uygulamaları: literatür derlemesi

“…Ağız içi distraktörler aynı zamanda daha tolere edilebilir olduklarından, ağızda konsolidasyon dönemi boyunca daha uzun sure retansiyonu sağlanabilmektedir. 24,37,[38][39][40] Ancak ağız içi distraktörlerle distraksiyon miktarı ve kuvvetlerin üç boyuttaki kontrolu daha sınırlı olmaktadır. 40 Bu distraktörler, bukkalden 3,4,40 veya palatinalden 24,29,38 uygulanabilmektedir.…”