Morphologic Evaluation for Safe Le Fort I Osteotomy in Cleft Lip and Palate

Watanabe, Miki; Watanabe, Akira; Takano, Nobuo; Saito, Chikara; Shibahara, Takahiko

doi:10.1177/1055665618757368

Cited by 6 publications

(4 citation statements)

References 31 publications

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“…The first 2 techniques require osteotomy, which can result in complications such as severe postoperative bleeding, inferior alveolar nerve damage, velopharyngeal incompetence, and postsurgical relapse, among others. [19][20][21][22] The TSDO technique applies an external force to the naturally existing cranial and facial sutures. This induces bone reconstruction and new bone formation around the sutures, which can effectively adjust the shape and position of the craniomaxillofacial skeleton to a certain extent without osteotomy.…”

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confidence: 99%

“…Three main surgical procedures are commonly used in the clinical treatment of midfacial hypoplasia: traditional orthognathic surgical techniques, maxillary distraction with osteotomy, and trans -sutural distraction osteogenesis (TSDO). The first 2 techniques require osteotomy, which can result in complications such as severe postoperative bleeding, inferior alveolar nerve damage, velopharyngeal incompetence, and postsurgical relapse, among others 19–22…”

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confidence: 99%

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Effect of Bone-Borne Trans-Sutural Distraction Osteogenesis Therapy on the Cranial Base of Children With Midfacial Hypoplasia Due to Cleft Lip and Palate

Zhang

Tong

Chen

et al. 2022

Journal of Craniofacial Surgery

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Bone-borne trans-sutural distraction osteogenesis (TSDO) is widely used to treat midfacial hypoplasia in children with cleft lip and palate; however, its effects on the cranial base are still poorly understood. The authors aimed to study morphological changes in the cranial base after TSDO. Pre and postoperative computed tomography (CT) images of cleft lip and palate children with midfacial skeleton dysplasia who underwent TSDO were collected retrospectively, and their corresponding 3-dimensional models were measured. Results showed no significant change in the length of the anterior or posterior cranial fossa, but the length of the middle cranial fossa increased significantly. The anterior cranial base rotated upward with the sella turcica at the center, whereas the cranial base angle increased. The sphenoid bone exhibited morphological changes. Post-TSDO, the lateral plate of the pterygoid process increased in length. The angle of the 2 lateral plates of the pterygoid process, the greater wings of the sphenoid bone, and the smaller wings of the sphenoid bone decreased. Posterior inclination of the pterygoid process increased. Mean volume of the sphenoidal sinus increased postoperatively compared with the preoperative volume. Apparent changes in the cranial base after TSDO are primarily in the middle cranial fossa, manifesting as an increase in the sphenoid bone body length, expansion of the sphenoidal sinus volume, growth of the pterygoid process forward and downward, a decrease in the angle of both the greater and smaller wings of the sphenoid bone, and an increase in the posterior inclination of the pterygoid process.

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confidence: 99%

mentioning

confidence: 99%

Effect of Bone-Borne Trans-Sutural Distraction Osteogenesis Therapy on the Cranial Base of Children With Midfacial Hypoplasia Due to Cleft Lip and Palate

Zhang

Tong

Chen

et al. 2022

Journal of Craniofacial Surgery

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“…A common management approach for growing children with CLP is cleft orthognathic surgery, including alveolar bone grafting, orthodontics, and orthognathic surgery such as Le Fort I osteotomy. However, osteotomy has been proven to result in complications such as malocclusion, inferior alveolar nerve damage, inadequate or incomplete splits, postoperative bleeding, velopharyngeal incompetence, and postsurgical relapse 7–10 . Instead, minimally invasive surgeries such as maxillary distraction osteogenesis (DO) have become an advantageous option.…”

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confidence: 99%

“…However, osteotomy has been proven to result in complications such as malocclusion, inferior alveolar nerve damage, inadequate or incomplete splits, postoperative bleeding, velopharyngeal incompetence, and postsurgical relapse. [7][8][9][10] Instead, minimally invasive surgeries such as maxillary distraction osteogenesis (DO) have become an advantageous option. A study showed that compared with the osteotomy group, the distraction group demonstrated greater maxillary advancement, lesser horizontal relapse of the maxilla, and higher life satisfaction.…”

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confidence: 99%

Influence of Bone-Borne Trans-Sutural Distraction Osteogenesis Therapy on the Hard Palate of Growing Children With Cleft Lip and Palate

Zhang

Chen

et al. 2021

Journal of Craniofacial Surgery

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The efficacy of trans-sutural distraction osteogenesis therapy (TSDO) in treating midfacial hypoplasia in children with cleft lip and palate has been confirmed. However, few studies have reported that changes occur in the palate after TSDO treatment. To study the effect of TSDO on palatal morphology and its relative position in the craniofacial region, we retrospectively collected and measured the computed tomography images of 29 growing children with cleft lip and palate and midfacial hypoplasia, before and after TSDO. The results showed that the length and height of the palate did not change significantly, but the width and arch length increased, and the anterior area was more pronounced than the posterior area, with the median palatine suture still centered without obvious deviation. This suggests lateral palate growth after distraction, most likely around the median palatine suture. The distance from the palate to the cranial base also increased after distraction, and the anterior nasal spine moved forward, whereas the palate rotated by an average of 10.04° downward from the center of the anterior nasal spine. The increasing distance between the palate and cranial base may result from the growth of the nasal bone or the skull base. The oropharyngeal airway volume was also increased by an average of 2256.36 mm3, which may be beneficial to children's ventilatory function. In conclusion, TSDO therapy has influence on patients’ palatal morphology and position, which should be considered before surgery.

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Cleft Maxillary Hypoplasia

Mathew

Mustafa

Mathai

2021

Oral and Maxillofacial Surgery for the Clinician

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Cleft lip and palate patients are born with a challenging deformity that requires multiple surgical interventions in order to reach functional and esthetic harmony. Mid face deficiency in cleft patients is a challenging clinical problem very often encountered in the management of this congenital defect. Cleft maxillary hypoplasia can be attributed to the inherited traits, acquired traits and Induced traits. CLP patients usually present with symptoms varying from malocclusion, retrusion of midface, and a narrow hard palate. A detailed evaluation and individualized treatment planning is of utmost importance in dealing with these patients. Treatment involves the contribution from both the orthodontist and the craniofacial team. The goals for the treatment for cleft maxillary hypoplasia are improvement of aesthetic deficits as well as correction of malocclusion.

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Morphologic Evaluation for Safe Le Fort I Osteotomy in Cleft Lip and Palate

Cited by 6 publications

References 31 publications

Effect of Bone-Borne Trans-Sutural Distraction Osteogenesis Therapy on the Cranial Base of Children With Midfacial Hypoplasia Due to Cleft Lip and Palate

Effect of Bone-Borne Trans-Sutural Distraction Osteogenesis Therapy on the Cranial Base of Children With Midfacial Hypoplasia Due to Cleft Lip and Palate

Influence of Bone-Borne Trans-Sutural Distraction Osteogenesis Therapy on the Hard Palate of Growing Children With Cleft Lip and Palate

Cleft Maxillary Hypoplasia

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