Use of repeat anterior maxillary distraction to correct residual midface hypoplasia in cleft patients

다국어 초록 (Multilingual Abstract)

Objectives: The study was designed to evaluate the efficacy of performing a second, repeat anterior maxillary distraction (AMD) to treat residual cleft maxillary hypoplasia.
Materials and Methods: Five patients between the ages of 12 to 15 years with a history of AMD and with residual cleft maxillary hypoplasia were included in the study. Inclusion was irrespective of gender, type of cleft lip and palate, and the amount of advancement needed. Repeat AMD was executed in these patients 4 to 5 years after the primary AMD procedure to correct the cleft maxillary hypoplasia that had developed since the initial procedure. Orthopantomogram (OPG) and lateral cephalograms were taken for evaluation preoperatively, immediately after distraction, after consolidation, and one year postoperatively. The data obtained was tabulated and a Mann Whitney U-test was used for statistical comparisons.
Results: At the time of presentation, a residual maxillary hypoplasia was observed with a well maintained distraction gap on the OPG which ruled out the occurrence of a relapse. Favorable movement of the segments without any resistance was seen in all patients. Mean maxillary advancement of 10.56 mm was achieved at repeat AMD. Statistically significant increases in midfacial length, SNA angle, and nasion perpendicular to point A distance was achieved (P=0.012, P=0.011, and P=0.012, respectively). Good profile was achieved for all patients. Minimal transient complications, for example anterior open bite and bleeding episodes, were managed.
Conclusion: Addressing the problem of cleft maxillary hypoplasia at an early age (12-15 years) is beneficial for the child. Residual hypoplasia may develop in some patients, which may require additional corrective procedures. The results of our study show that AMD can be repeated when residual deformity develops with the previous procedure having no negative impact on the results of the repeat procedure.

목차 (Table of Contents)

• Abstract
• Ⅰ. Introduction
• Ⅱ. Materials and Methods
• Ⅲ. Results
• Ⅳ. Discussion
• Ⅴ. Conclusion
• Conflict of Interest
• ORCID
• References

참고문헌 (Reference)

1 Block MS, "Use of distraction osteogenesis for maxillary advancement: preliminary results" 52 : 282-286, 1994

2 Ross RB, "Treatment variables affecting facial growth in complete unilateral cleft lip and palate" 24 : 5-77, 1987

3 Precious DS, "Treatment of retruded maxilla in cleft lip and palate--orthognathic surgery versus distraction osteogenesis: the case for orthognathic surgery" 65 : 758-761, 2007

4 Dogan S, "The effects of face mask therapy in cleft lip and palate patients" 2 : 116-120, 2012

5 Janulewicz J, "The effects of Le Fort I osteotomies on velopharyngeal and speech functions in cleft patients" 62 : 308-314, 2004

6 Posnick JC, "Skeletal stability and relapse patterns after Le Fort I maxillary osteotomy fixed with miniplates: the unilateral cleft lip and palate deformity" 94 : 924-932, 1994

7 Oluwajana F, "Seeking beauty: understanding the psychology behind orthognathic surgery" 53 : 953-956, 2015

8 Richardson S, "Perceptual speech assessment after anterior maxillary distraction in patients with cleft maxillary hypoplasia" 74 : 1239.e1-1239.e9, 2016

9 Dolanmaz D, "Maxillary anterior segmental advancement by using distraction osteogenesis: a case report" 73 : 201-205, 2003

10 Hirano A, "Factors related to relapse after Le Fort I maxillary advancement osteotomy in patients with cleft lip and palate" 38 : 1-10, 2001

11 Wolford LM, "Considerations for orthognathic surgery during growth, part 2: maxillary deformities" 119 : 102-105, 2001

12 Guyette TW, "Changes in speech following maxillary distraction osteogenesis" 38 : 199-205, 2001

13 Bengi O, "Cephalometric evaluation of patients treated by maxillary anterior segmental distraction: a preliminary report" 35 : 302-310, 2007

14 Wang XX, "Anterior maxillary segmental distraction for correction of maxillary hypoplasia and dental crowding in cleft palate patients: a preliminary report" 38 : 1237-1243, 2009

15 Gunaseelan R, "Anterior maxillary distraction by tooth-borne palatal distractor" 65 : 1044-1049, 2007

16 Bansal A, "A noble, easy and conceptual radiographic analysis to assess the type of tooth movement (molar distalization)" 9 : ZC22-ZC25, 2015

17 McNamara JA Jr, "A method of cephalometric evaluation" 86 : 449-469, 1984

18 Cheung LK, "A meta-analysis of cleft maxillary osteotomy and distraction osteogenesis" 35 : 14-24, 2006