Treatment of a Patient with Cleft Lip and Palate Using an Internal Distraction Device

Abstract

A 24-year-old man with a bilateral cleft lip and palate was treated by a multidisciplinary team composed of an orthodontist, plastic surgeon, and prosthodontist with assistance from an engineer. Before treatment, clinical photographs, dental casts, lateral and posteroanterior cephalograms, periapical and panoramic radiographs, and three-dimensional computed tomography (3D CT) images were obtained. He presented with a narrow and retrognathic maxilla with a 23-mm anterior open bite. Following maxillary expansion with rapid palatal expansion, a Le Fort I maxillary osteotomy was performed, and an internal distractor was placed. After a 5-day latency period, internal maxillary distraction was performed at a rate of 1 mm/day achieved by two activations per day. Cephalometric analysis showed a 7-mm maxillary advancement. Mandibular bilateral sagittal split osteotomy was also performed to close the open bite following maxillary distraction and a 3-month stabilization period. Finally, the treatment was completed with prosthetic rehabilitation. The changes in speech production were evaluated using an automatic speech recognition system.

Initial Experience With a New Intraoral Midface Distraction Device

“…Advantages of the RED include vector control, single surgery, and ability to use when there is insufficient or poor quality bone. 10 , 12 , 13 , 17 , 18 These devices, however, are psychologically and socially burdensome and can cause scarring, scalp osteitis, intracranial pin migration, skull fractures, and loosening of device or tooth. 8 , 11 , 16 , 18 Because they stay in place until consolidation occurs (6–12 weeks), they pose a significant burden on patients and families, and may not be well tolerated.…”

“… 5 , 6 , 9 , 16 , 18 – 20 Internal devices tend to be better tolerated and more inconspicuous; however, they are single vector thus requiring precise parallel placement, a second surgery to remove hardware, and sufficient bone stock to anchor, and may require a three-dimensional model for proper placement. 5 , 6 , 8 , 14 , 18 In addition, many of the devices used have a limited distraction length. Chua and Hägg 15 argue that internal distractors provide better long-term stability than external distractors because internal distractors transpose, and do not pull maxilla, which may decrease relapse rates.…”

“…We are applying this to children as young as 6 years of age, in whom the tooth buds have descended to the point where modified high osteotomies can be made safely and effectively, especially with the aid of three-dimensional models that demonstrate the position of tooth buds. 6 , 10 , 17 , 18 Eliminating rigid fixation also protects the tooth buds. This technique allows us to correct aesthetic as well as functional problems, such as sleep apnea, at an early age instead of waiting for definitive surgery when the patient is in the teens.…”

A Systematic Review of Artificial Intelligence Applications in Plastic Surgery: Looking to the Future

“…All but eight studies (n = 36, 82%) provided disclosures. A study aim was clearly stated in all papers, and all but two articles 67,68 reported the data Fig. 3.…”

Experimental evaluation of susceptibility to fractures of the orbital floor in patients with unilateral complete cleft palate

“…Because of its clinical importance, a wide range of studies concerning its treatment [1][2][3][4][5], morphological analysis [6], diagnosis [7], and aetiology [8], has been reported. Despite extensive research, few studies exist about the risk of facial fracture in patients with unilateral complete cleft palate.…”