Long-term results in maxillary deficiency using intraoral devices.

Department of Oral and Maxillofacial Surgery, Rambam Medical Center, Haifa, Israel.
International Journal of Oral and Maxillofacial Surgery (Impact Factor: 1.36). 08/2005; 34(5):473-9. DOI: 10.1016/j.ijom.2005.01.004
Source: PubMed

ABSTRACT Cleft lip and palate patients often present maxillary retrusion and class III malocclusion after cleft repair. Maxillary distraction is a technique that can provide simultaneous skeletal advancement and expansion of soft tissue. Twelve patients with cleft maxillary deficiency due to cleft lip and palate were treated by Le Fort I osteotomy and two intraoral distraction devices that were activated after 4 days of latency period, 1mm per day on both sides. Long-term clinical and cephalometric evaluation of one and two years demonstrate stable results concerning the skeletal, dental and soft tissue relations. In this paper we discuss the advantages of distraction osteogenesis as a method for treatment of maxillary deficiency in cleft patients in terms of stability and relapse. The indications for maxillary distraction: (1) Moderate and severe retrusion that needs large advancement as in cleft lip and palate patients. (2) Forward and downward lengthening of the maxilla with no need for intermediate bone graft. (3) Growing patients. In conclusion, maxillary distraction in moderate or severe retrusion, as in cleft patients offers marked maxillary advancement with long-term stability.

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    ABSTRACT: Background: Maxillary distraction osteogenesis (DO) in cleft lip and palate patients has been described by several authors, but most studies have a relatively short follow-up and do not clearly separate growing patients from non-growing patients. Method: The records of 22 consecutive patients affected by cleft lip and palate, who underwent Le Fort I osteotomy and maxillary distraction with a rigid external distractor (RED), were reviewed. The sample was subdivided into a growing and a non-growing group. All patients had pre-DO cephalometric records, immediately post DO, 12 months post DO and long-term records with a long-term follow-up of >5 years (range 5-13 years). As a control sample for the growing group, cleft children with a negative overjet not subjected to distraction or any protraction treatment during growth were followed up until the completion of growth. Results: The average maxillary advancement in the growing group was 22.2 +/- 5.5 mm (range: 15-32 mm); in the non-growing group, it was 17.7 +/- 6.6 mm (range: 6-25 mm). Excellent post-surgical stability was recorded in the adult sample. On the other hand, growing children had an average 16% relapse in the first year post DO and an additional 26% relapse in the long-term follow-up. Conclusions: This study seems to point out that early Le Fort I DO allows for the correction of very severe deformities. It is followed by a relatively high amount of true skeletal relapse in children with cleft lip and palate. Prognosis should be discussed in depth with the family and true aesthetic and psychological needs assessed.
    Journal of Plastic Reconstructive & Aesthetic Surgery 09/2014; 68(1). DOI:10.1016/j.bjps.2014.08.069 · 1.47 Impact Factor
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    ABSTRACT: Gradual bone lengthening using distraction osteogenesis principles is the gold standard for the treatment of hypoplastic facial bones. However, the long treatment time is a major disadvantage of the lengthening procedures. The aim of this study is to review the current literature and summarize the cellular and molecular events occurring during membranous craniofacial distraction osteogenesis. Mechanical stimulation by distraction induces biological responses of skeletal regeneration that is accomplished by a cascade of biological processes that may include differentiation of pluripotential tissue, angiogenesis, osteogenesis, mineralization, and remodeling. There are complex interactions between bone-forming osteoblasts and other cells present within the bone microenvironment, particularly vascular endothelial cells that may be pivotal members of a complex interactive communication network in bone. Studies have implicated number of cytokines that are intimately involved in the regulation of bone synthesis and turnover. The gene regulation of numerous cytokines (transforming growth factor-β, bone morphogenetic proteins, insulin-like growth factor-1, and fibroblast growth factor-2) and extracellular matrix proteins (osteonectin, osteopontin) during distraction osteogenesis has been best characterized and discussed. Understanding the biomolecular mechanisms that mediate membranous distraction osteogenesis may guide the development of targeted strategies designed to improve distraction osteogenesis and accelerate bone regeneration that may lead to shorten the treatment duration.
    01/2014; 2(1):e98. DOI:10.1097/GOX.0000000000000043
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    ABSTRACT: Objective: The aim was to examine the treatment effectiveness and relapse of maxillary advancement, among 3 types of surgery in cleft patients: (1) conventional orthognathic surgery (CO), (2) extraoral distraction osteogenesis (EDO), and (3) intraoral distraction osteogenesis (IDO). Materials and methods: Using 6 electronic databases: Medline, Embase, Cochrane, ISI, Scopus, and Google Scholar. 336 cephalometric measurements were examined from 141 full text papers. For maxillary position, only SNA was eligible according to the criteria for meta-analysis. Heterogeneity test, estimation of pooled means, publication bias, and sensitivity analysis were performed. Results: Estimation of pooled means revealed the following results. The SNA at pre-treatment, post-treatment, and follow-up in CO group were 72.6, 77.6, 76.1 degrees, for EDO group were 74.4, 83.3, 83.1 degrees, and for IDO group were 73.3, 81.3, 82.1 degrees respectively. Indirect comparison of pooled mean estimate showed that the maxillary position was relatively similar at pre-treatment among the 3 groups. The maxilla was advanced +4.96 degrees in CO group, +8.93 degrees in EDO group, and +8.06 degrees in IDO group. At 1 year follow-up, the CO showed more relapse rate than EDO, however, small forward advancement was shown for IDO (−30.24%, −2.79% and +9.93% respectively). Limitations of study involved questionable quality of paper included as there was no RCT study. Conclusions: EDO and IDO might advance the maxilla greater than CO. Normalization of maxillary position was achieved using EDO and IDO, while the maxilla position in CO group was slightly retrognathic after surgery. At 1-year follow-up, CO showed greater relapse of SNA than EDO and IDO.
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