Long-term stability after craniofacial distraction osteogenesis

Orthodontic Graduate Program, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons (Impact Factor: 1.28). 10/2008; 66(9):1812-9. DOI: 10.1016/j.joms.2007.08.026
Source: PubMed

ABSTRACT This study was conducted to systematically review long-term skeletal stability after craniofacial distraction osteogenesis.
Several electronic databases (Old Medline, Medline, Medline In-Process and Other Non-Indexed Citations, Pubmed, Embase, Web of Science, and all EBM reviews [Cochrane Database of Systematic Reviews, ACP Journal Club, DARE, and CCTR]) were searched. Key words used in the search were "distraction," "osteogenesis," "craniofacial," "maxillofacial," "stability," "relapse," and "recurrence." MeSH terms and truncations of these terms were selected with the help of a health science librarian. Abstracts that appeared to contain at least 3 years of postsurgical data were selected. The original articles were then retrieved and evaluated to ensure that they actually had 3 years of data after craniofacial distraction osteogenesis. The references were also hand-searched for possible missing articles that were not indexed in the searched databases.
A total of 118 abstracts were found in the electronic searches. After the first set of selection criteria was applied on these abstracts, 22 articles were retrieved. After the final selection criteria were applied on these 22 articles, only 6 articles were finally selected. These 6 articles reported long-term stability after craniofacial distraction osteogenesis. Sample sizes were small, and the methodological quality of the studies was poor.
Although, based on the selected studies, craniofacial bone distraction osteogenesis appeared to show long-term stability; limitations of the studies merit caution in interpreting these findings. Some early relapse occurred in the first 3 years postdistraction, but stability was maintained thereafter. Some methodologically sounder studies are needed to confirm the present findings.


Available from: Saleh Al-Daghreer, May 29, 2015
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    ABSTRACT: Surgically Assisted Rapid Maxillary Expansion (SARME) is frequently used to treat skeletal maxillary transverse deficiency (MTD) in skeletally mature and non-growing individuals. Despite previous research in the field, questions remain with respect to the long-term stability of SARME and its effects on hard and soft tissue. The overall aim of the present doctoral work was to achieve a greater understanding of SARME, using modern image technology and a multidisciplinary approach, with special reference to effects on the hard and soft tissues and respiration. A more specific aim was to evaluate the long-term stability in a retrospective sample of patients treated with SARME and orthodontic treatment and to compare the results with a matched, untreated control group. The studies in this doctoral project are thus based on two different samples and study designs. The first sample, Study I (Paper I), is a retrospective, consecutive, long-term follow-up material of study models from 31 patients (17 males and 14 females) treated with SARME and orthodontic treatment between 1991 and 2000. The mean pre-treatment age was 25.9 years (SD 9.6) with a mean follow-up time of 6.4 years (SD 3.3). Direct measurements on study models were made with a digital sliding caliper at reference points on molars and canines. To evaluate treatment outcome and long-term stability, the results were compared with study models from an untreated control group, matched for age, gender and follow-up time. The second sample, Study II (Papers II-IV), is a prospective consecutive, longitudinal material of 40 patients scheduled to undergo SARME and orthodontic treatment between 2006 and 2009. In Paper II, one patient was excluded because of a planned adenoidectomy. The final sample comprised 39 patients (16 males and 23 females). The mean age at treatment start was 19.9 years (range 15.9 - 43.9). Acoustic rhinometry, rhinomanometry and a questionnaire were used to assess the degree of nasal obstruction at three time-points; pre-treatment, three months after expansion and after completed treatment (mean 18 months). In Papers III-IV, three patients declined to participate and two had to be excluded because their CT-records were incomplete. The final sample comprised 35 patients (14 males and 21 females). The mean age at treatment start was 19.7 years (range 16.1 - 43.9). Helical CT-images were taken pre treatment and eighteen months' post-expansion. 3D models were registered and superimposed at the anterior cranial base. The automated voxel-based image registration method allows precise, accurate measurements in all areas of the maxilla. In Papers II-IV, the treatment groups constituted their own control groups. The main findings in the retrospective, long-term follow-up study were that SARME and orthodontic treatment normalized the transverse discrepancy and was stable for a mean of 6 years post-treatment. Pterygoid detachment did not entirely eliminate the side effect of buccal tipping of the posterior molars. Relapse is time-related and is most pronounced during the first 3 years after treatment. Thus the retention period should be extended and should be considered for this period. The main rhinological findings in the prospective longitudinal study were that SARME had a short-term, favourable effect on nasal respiration, but the effect did not persist in the long-term. However, subjects with pretreatment nasal obstruction reported a lasting sensation of improved nasal function. SARME and orthodontic treatment had a significant but non-uniform skeletal treatment effect, with significantly greater expansion posteriorly than anteriorly. The expansion was parallel anteriorly but not posteriorly. The lateral tipping of the posterior segment was significant, despite careful surgical separation. No correlation was found between tipping and the patient's age. Furthermore, SARME and orthodontic treatment significantly affected all dimensions of the external features of the nose. The most obvious changes were at the most lateral alar-bases. The difference in lateral displacement profoundly influenced the perception of a more rounded nose. There were no predictive correlations between the changes. Patients with narrow and constrained nostrils can benefit from these changes with respect to the subjective experience of nasal obstruction. It is questionable whether an alar-cinch suture will prevent widening at the alar-base. The 3D superimposition applied in Study II is a reliable method, circumventing projection and measurement errors. In conclusion, SARME and orthodontic treatment normalize the transverse deficiency, with long-term stability. SARME has a favourable effect on the subjective perception of nasal respiration. SARME significantly affects dental, skeletal and nasal structures.
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    ABSTRACT: Abstract Objective: To evaluate the long-term maxillomandibular changes after maxillary distraction osteogenesis (DOG) in growing children having cleft lip with or without cleft palate (CL±P). Patients: Eight Japanese patients with CL±P aged 9.3-13.1 years. Measures: The maxillary and mandibular positions before (T0), immediately after (T1), and 1, 3, and 5 years after DOG (T2, T3, and T4) measured on cephalograms superimposed at the sella turcica (S) with the Frankfurt horizontal (FH) plane as the horizontal reference. The anterior nasal spine [ANS(x, y)], pogonion [Pog(x)], and menton [Me(y)] were used for linear measurements, and S-nasion-point A (SNA), S-nasion-point B (SNB), and point A-nasion-point B (ANB) angles were used for angular measurements. Results: The mean horizontal maxillary advancement [ANS(x)] was +12.3 mm during T0-T1, but -2.7, -1.1, and -0.1 mm of the post-treatment changes were observed during T1-T2, T2-T3, and T3-T4, respectively. ANS(y) shifted 2.3 mm downward during T0-T1, and further downward changes were observed during T1-T2 and T2-T3 (P < 0.05). Pog(x) did not show distinct changes due to individual variance, but Me(y) shifted downward from T1 to T4. SNA significantly decreased during T1-T2 and T2-T3 but not during T3-T4. ANB significantly decreased only during T2-T3, and SNB did not show any distinct change. Conclusions: There was no further maxillary advancement after DOG in the growing children with CL±P. Therefore, long-term observation and management of occlusion in case of the mandibular growth pattern are important. Key Words: distraction osteogenesis, cleft lip and palate, maxilla, growth, relapse.
    The Cleft Palate-Craniofacial Journal 03/2012; DOI:10.1597/11-177 · 1.11 Impact Factor
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    ABSTRACT: Objective : This study was conducted to review the changes in airways after maxillary anterior advancement by distraction osteogenesis in patients with cleft lip and palate. Materials and Methods : Several electronic databases were searched. The selection criteria were set to include clinical trials and at least 1 year of postsurgical data. The original articles were then retrieved and evaluated by two investigators to ensure that they met the selection criteria. The references were also hand searched for possible missing articles. Results : Forty-three abstracts were found in the electronic searches. After the first set of selection criteria was applied to these abstracts, 14 articles were retrieved. After the final selection criteria, only four articles were finally selected. However, sample sizes of the selected articles were small, and the methodological quality of the studies was inadequate. All selected articles were consistent in that upper airway sizes increased and nasal resistance was reduced after distraction osteogenesis. Conclusions : Despite the consistency of increasing the upper airway size and reducing nasal resistance in the only four found articles, limitations of the studies merit caution in interpreting these findings. We conclude that there are insufficient prospective randomized controlled clinical trials to confirm these results.
    The Cleft Palate-Craniofacial Journal 07/2011; 49(3):255-61. DOI:10.1597/11-031 · 1.11 Impact Factor