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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    • "The treatment options for this deformity include conventional orthognathic surgery and internal or external distraction osteogenesis (DO) (Cohen et al., 1997; Polley and Figueroa, 1997; Karakasis and Hadjipetrou, 2004; Gedrange et al., 2006; Nada et al., 2010). Maxillary DO in CLP has been proven to have a good long-term stability (Figueroa et al., 2004; Rachmiel et al., 2005; Cho and Kyung, 2006; Aksu et al., 2010; Chua et al., 2010; Gürsoy et al., 2010; Chen et al., 2011), but it must be used judiciously for the right indications, so that its benefits can compensate its disadvantages (Cheung et al., 2006; Precious, 2007; Chua et al., 2012). "
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    ABSTRACT: PURPOSE: The objective was to analyze the effects of growth on the long-term result of maxillary distraction osteogenesis (DO) in cleft lip and palate (CLP). PATIENTS AND METHODS: Retrospective study of 24 CLP cases with long-term follow-up operated for maxillary DO using the Polley and Figueroa technique: 10 patients were distracted during growth, while 14 patients were operated after their growth spurt. Preoperative (T0), 6-12 months postoperative (T1), and ≥4 years postoperative (T2) cephalometric radiographs were evaluated. A classical cephalometric analysis was used to assess the treatment stability, and a Procrustes superimposition method was performed to assess local changes in the maxilla and the mandible. RESULTS: At T0, the mean age was of 11.9 ± 1.4 years for growing patient, and 17.9 ± 3.5 years for patient treated after their growth spurt (P < 0.001). Between T0 and T1, a greater increase of the SNA was shown in growing patients (P = 0.036), but the relapse was more important between T1 and T2, with a significant decrease of the SNA (P = 0.002) and ANB (P = 0.032) compared to the patients treated after their growth spurt. Although not significant, growing patients showed greater rotations of their palatal plane and mandibular plane. CONCLUSIONS: Maxillary DO in CLP does not correct the growth deficit inherent to the pathology. Overcorrection of at least 20% is advised during growth.
    Journal of cranio-maxillo-facial surgery: official publication of the European Association for Cranio-Maxillo-Facial Surgery 03/2013; 41(8). DOI:10.1016/j.jcms.2013.01.038
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    • "Insufficient analysis of the airways Birgfeld et al. (2007) Insufficient analysis of the airways Huang et al. (2007) Insufficient analysis of the airways Minami et al. (2007) 3D computer-assisted surgery Yamauchi et al. (2006) Novel technique used Rachmiel et al. (2005) Insufficient analysis of the airways Liou et al. (2004) Novel technique used Swennen et al. (1999) Inadequate follow-up Figueroa et al. (1999) Insufficient analysis of the airways Polley et al. (1998) Insufficient analysis of the airways However, in all of the four studies selected for inclusion in this systematic review, velopharyngeal morphology was assessed using lateral cephalometric films. Lateral cephalograms provide two-dimensional data in the midsagittal plane. "
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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
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    • "Internal maxillary distraction has been widely used in the treatment of cleft palate patients; however, it cannot yet be considered a fully predictable treatment modality. One of the most important factors in this technique is the placement vector of the two distractors (Nakagawa et al., 2003; Yamaji et al., 2004; Gateno et al., 2005; Rachmiel et al., 2005; Gulsen et al., 2007; Van Sickels et al., 2007). The placement vector of the distractors tends to change with advancement of the maxilla. "
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    ABSTRACT: Objective: The purpose of this cephalometric study was to compare the actual movement with the planned movement of the maxilla by using internal maxillary distraction in cleft lip and palate patients. Patients: Twelve patients, including eight with unilateral and four with bilateral cleft lip and palate, underwent maxillary advancement with internal maxillary distractors. Main Outcome Measures: Lateral cephalometric radiographs obtained preoperatively, predistraction, and postdistraction were used for analysis. The movement of the maxilla, angular change of the internal devices and rotation of the mandible were measured at each stage, and the planned vector of advancement predicted from the placement vector of the distractors was compared with the actual vector. Results: Internal maxillary distractors were rotated in a clockwise direction during the distraction period. The angular change of the distractors was 7.7°. The amount of actual advancement at anterior nasal spine with distraction was 6.3 mm, which represented about 70% of the distance of activation of distraction. The actual advanced vector at anterior nasal spine was 9.7° smaller than the planned vector. The mandible underwent a clockwise rotation of 3.5°. Conclusion: In the internal distraction technique, the maxilla was advanced inferiorly to the planned vector and with a slight clockwise rotation. These results are useful for surgical planning when using internal distractors.
    The Cleft Palate-Craniofacial Journal 03/2011; 48(2):161-6. DOI:10.1597/09-073
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