Midfacial Changes Through Anterior Maxillary Distraction Osteogenesis in Patients With Cleft Lip and Palate

Abstract

Maxillary hypoplasia is a major issue in cleft lip and palate patients, and predictable surgical maxillary advancement is required. In the present study, the changes and stability of the maxilla and soft tissue profile achieved after the application of anterior maxillary distraction osteogenesis (AMDO) using intraoral expander in unilateral cleft lip and palate and isolated cleft palate patients were investigated by comparing to the Le Fort I osteotomy (LFI) and maxillary distraction osteogenesis (DO) with rigid external distraction (RED) system.Ten patients who underwent orthognathic treatment with AMDO were examined (AMDO group). Changes in the positions of soft and hard tissue landmarks were calculated from the lateral cephalograms taken before the distraction, at the end of the distraction, and 1 year after the surgery. They were compared with the changes in 7 other unilateral cleft lip and palate patients who underwent LFI (LFI group) and 6 others who underwent DO with RED (RED group).The mean maxillary advancement of the AMDO group was similar to that of the RED group, judged by the change of point A. During DO, the AMDO group showed less clockwise rotation of mandible compared to the RED group. The soft tissue advancement of the upper lip and nose in the AMDO group was similar to that in the RED group, which was significantly larger than that in the LFI group.Our results indicate that AMDO can be surgical option to cleft lip and palate patients with less invasive but excellent improvement in both midfacial skeletal and soft tissue similar to DO-RED.

A 3-Dimensional Measurements of Bone and Airway Variables After Le Fort I Distraction Osteogenesis in Patients With Cleft Lip and/or Palate-Induced Midface Hypoplasia: A Retrospective Study

“…In the current study, the mandible rotated backward and downward without surgical intervention to fit the new position of the maxilla after distraction. These findings are consistent with those of previous studies reporting clockwise rotation of the mandible, [26][27][28] although other studies have reported the absence of significant changes in the sella-nasion-B angle 51,52 or the posterior rotation of the mandible. 53 It may be that the occlusal relationship is altered when the maxilla is displaced.…”

“…These findings are consistent with those of other studies. [26][27][28] Furthermore, a 3-dimensional analysis of airway variables and spaces after the movement of the bony structures revealed that 4 out of 5 zones of airway space (ie, nasal cavity, nasopharynx, velopharynx, and upper oropharynx) exhibited significant increases in volume after distraction, whereas no changes were noted in the volume of the lower oropharyngeal airway. The analysis also revealed a correlation between airway variables and the horizontal advancement of the maxilla.…”

Rationale and design for efficacy and safety evaluation of Bone-Anchored Maxillary Protraction (BAMP) for patients with unilateral cleft lip and palate with skeletal anterior crossbite: a single-arm, open-label, non-randomised prospective study protocol

“…Therefore, conventional facemask therapy used between the mixed dentition and the end of adolescent growth is not always the best treatment for patients with skeletal crossbite. If the degree of skeletal malocclusion is severe, then surgical procedures such as Le Fort I osteotomy or anterior maxillary distraction osteogenesis 7 are useful to correct the skeletal disharmony after completion of adolescent growth. In recent years, the number of cases showing marked growth suppression of the maxilla has decreased because of surgical technique improvement.…”

Three-Dimensional Facial Soft Tissue Changes After Orthognathic Surgery in Cleft Patients Using Artificial Intelligence-Assisted Landmark Autodigitization

“…Numerous studies have attempted to evaluate the facial soft tissue changes following OGS or DO and determine the correlations and ratios of soft-to-hard tissue changes in cleft lip and palate (CL/P) patients 8–19 . However, the facial soft tissues of CL/P patients differ from those of noncleft normal patients morphologically and behaviorally owing to the cleft-related deformity itself and scar tissues in the lip, nose, and alveolus 20,21 …”