Trans-sinusoidal maxillary distraction in three cleft patients

Wenghoefer, Matthias; Martini, M.; Nadjmi, Nasser; Schutyser, Filip; Jagtman, A.K.; Berge, S.

doi:10.1016/j.ijom.2006.07.015

Cited by 9 publications

(6 citation statements)

References 17 publications

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“…The problem was an unplanned clockwise maxillary rotation during distraction once a maxillary advancement started due to deviation between the distraction vectors at the beginning and at the end of distraction. This problem is well known [4], but it has not been described as severely as in this report, and has not been linked to the necessity of a bimaxillary osteotomy to overcome this misdirected distraction [12][13][14]. In a report of three patients with repaired cleft lip and palate, Gateno et al [15] observed a clockwise rotation of the maxilla with a tendency to a posterior open-bite and a difference between the actual distraction vectors and the planned vectors.…”

Section: Discussionmentioning

confidence: 57%

“…Additionally, some other factors may have played a more or less important part in distraction deviation. In particular in patient 2, it was critical to place the distractors parallel to each other on both sides of the maxilla, parallel to the sagittal plane, and additionally in a transverse angle of 5°to achieve a palatal widening as described in previous studies [8,12]. Sufficient bony support was required to anchor the devices to the zygomatic buttress that could not be exactly evaluated with a SLT model.…”

Section: Discussionmentioning

confidence: 99%

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Limitations of Internal Distraction Devices in Mature Patients with Cleft Lip and Palate and Severe Midface Hypoplasia

Rustemeyer

Busch

Bremerich

2011

J. Maxillofac. Oral Surg.

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Purpose We evaluated case-sensitive limitations of internal distraction devices (IDDs) to reveal further options for satisfactory outcomes. Patients and Methods Two male cleft patients aged 22 years (P1) and 20 years (P2) with severe maxillary hypoplasia were treated over 18 months. Cephalometric analyses and analyses of A-point movements by superimposing lateral cephalograms were done before and after activation of IDDs and after bimaxillary surgery (BIMAX). Results After activating IDDs, the vectors deviated and clockwise rotation of the maxilla and vectors occurred. After 8 months, BIMAX was needed to carry out further maxillary advancement. Conclusions IDDs could pave the way to achieve maximal advancement with BIMAX in a second step and justify the overall treatment when comparing the initial situation with outcome.

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Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Limitations of Internal Distraction Devices in Mature Patients with Cleft Lip and Palate and Severe Midface Hypoplasia

Rustemeyer

Busch

Bremerich

2011

J. Maxillofac. Oral Surg.

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“…The presence of incomplete osteotomies has also been reported by several authors [3,14,22]. Dolanmaz et al [23] also have observed different types of unpredictable fractures after the DF procedures in a group of cadavers.…”

Section: Discussionmentioning

confidence: 58%

Dentoalveolar changes following maxillary distraction osteogenesis

Yang¹,

Suzuki²,

Suzuki³

2013

OJST

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The purpose of this study was to compare the dentoalveolar changes produced when using two different intraoperative surgical procedures for maxillary distraction osteogenesis. Eight patients were assigned into two groups according to the surgical procedure: down-fracture (DF, n = 6) vs non-down-fracture (NDF, n = 2). Lateral cephalograms and 3-D models before and after maxillary distraction were analyzed. The Mann-Whitney U test was used to compare the differences in the amounts of advancement and dento-alveolar changes between the DF and NDF groups. The significance level was established at 0.05. Although a significantly greater amount of maxillary movement was observed in the DF group (10.0 mm ± 2.2) than in the NDF group (5.9 mm ± 2.3), significantly greater arch length (8.7 mm ± 5.2) and arch width changes (6.0 mm ± 1.0) were observed in the NDF group than in the DF group, (arch lengths 3.0 mm ± 1.1 and arch width changes 3.2 mm ± 2.0). A significantly greater amount of dental anchorage loss was observed in the NDF group. The use of the NDF procedure resulted in greater amounts of dental anchorage loss than resulted from the DF procedures when tooth-borne devices were used during maxillary distraction osteogenesis. The type of surgical procedure might play an important role in the amount and direction of the dental changes.

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“…This is very significant for patients with cleft lip and/or palate, for they often need maxillary advancement of more than 10 mm to achieve a normal facial appearance and occlusal relationship. [23][24][25] At this point, even though the postdistraction growth cannot be accurately predicted, the procedure allows better growth and psychosocial development and minimizes the amount of sagittal discrepancy if a second surgery is needed. Maintaining teeth in their corrected position after orthodontic treatment is challenging, and practitioners commonly recommend long-term or permanent retention.…”

Section: Discussionmentioning

confidence: 99%

Orthodontic Considerations for Maxillary Distraction Osteogenesis in Growing Patients with Cleft Lip and Palate Using Internal Distractors

Silveira

Moura²,

Harshbarger

2014

Seminars in Plastic Surgery

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Maxillary hypoplasia is a common developmental problem in patients with cleft lip and palate (CLP), and normally results from a combination of a congenital reduction in midfacial growth and the effects of the surgical scar from cleft palate repair. 1,2 As a result, CLP patients usually present with class III malocclusion, a retruded midface, and a narrow hard palate. In most situations, surgical correction following cessation of growth is required to treat severe skeletal disharmony. However, individualized evaluation and treatment planning is recommended. [3][4][5] The technique of DO has provided new ideas and methods for the correction of sagittal, vertical, and transversal maxillary discrepancies. 6-9 Distraction osteogenesis gradually lengthens both the bones and the soft tissues, then greatly lowers the soft tissue restriction around the distracted segment and lowers the relapse rate. The technique of Le Fort I DO using an internal device is potentially a predictable, stable, and convenient option for the correction of a severe unfavorable intermaxillary relationship. It is an alternative option for treatment of maxillary hypoplasia in growing CLP patients where continued growth of the mandible is expected. 10,11 In the craniofacial team setting, the orthodontist assists in planning distraction surgery, developing or adapting distraction devices, and managing postsurgical results. Our purpose here is to describe the orthodontic approach to the management of cleft patients with severe maxillary deficiency with the use of an internal distraction device. The information is Keywords ► internal Le Fort I distractor ► maxillary distraction ► distraction osteogenesis ► maxillary hypoplasia ► cleft lip and palate AbstractThe orthodontist plays a key role in the selection of the optimal treatment for patients followed by a craniofacial team. For patients with cleft lip and palate, the need for multidisciplinary treatment planning and sequentially staged treatment is essential for successful patient outcomes. The technique of Le Fort I distraction osteogenesis of the maxilla using an internal device is potentially a predictable, stable, and convenient option for the correction of severe maxillary hypoplasia. It is an alternative option for treatment of maxillary hypoplasia in growing patients. In this article, the authors describe the orthodontist's approach to the management of cleft patients with severe maxillary deficiency with the use of an internal distraction device. The information is presented with a focus on the clinical aspects of treatment, using case illustrations and appropriate literature.

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Trans-sinusoidal maxillary distraction in three cleft patients

Cited by 9 publications

References 17 publications

Limitations of Internal Distraction Devices in Mature Patients with Cleft Lip and Palate and Severe Midface Hypoplasia

Limitations of Internal Distraction Devices in Mature Patients with Cleft Lip and Palate and Severe Midface Hypoplasia

Dentoalveolar changes following maxillary distraction osteogenesis

Orthodontic Considerations for Maxillary Distraction Osteogenesis in Growing Patients with Cleft Lip and Palate Using Internal Distractors

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