A protocol used to manage maxillary hypoplasia in cleft lip and palate patients
Affiliation(s)
Oral and Maxillofacial Surgery Department, King Abdulaziz University, Jeddah, Saudi Arabia.
Oral and Maxillofacial Surgery Department, King Abdulaziz University, Jeddah, Saudi Arabia.
ABSTRACT
Objectives: We report our experience and the protocol we used in managing maxillary hypoplasia in cleft lip and palate patients. Patients and methods: 14 adult cleft lip and palate patients with maxillary hypoplasia were evaluated clinically. Dental models and radiographs including (lateral cephalograms and orthopantographs) were obtained at the initial visit and upon completion of the presurgical orthodontic treatment. Patients with occlusal discrepancies larger than 6 mm and severe palatal scaring underwent Distraction osteogenesis (DO) to advance the maxilla. Patients with an occlusal discrepancy of 6 mm or less, underwent traditional orthognathic surgery including le fort I advancement and Bilateral sagittal split osteotomy (BSSO) to seat the mandible in occlusion. Results: Five patients underwent orthognathic surgery. Two of them underwent double jaw surgery. Three underwent single jaw conventional le fort l advancement. Four patients required bone grafting to repair the residual alveolar defect and to augment the midface deficiency. Nine patients with severe maxillary hypoplasia underwent maxillary advancement using distraction osteogenesis. Conclusion: Patients with a severe maxillary hypoplasia of 6 mm or more and excessive palatal scaring are successfully treated with DO. Conventional le fort I is reserved for patients with less severe maxillary hypoplasia. Both techniques gave promising results providing having followed the proper selection criteria.
Objectives: We report our experience and the protocol we used in managing maxillary hypoplasia in cleft lip and palate patients. Patients and methods: 14 adult cleft lip and palate patients with maxillary hypoplasia were evaluated clinically. Dental models and radiographs including (lateral cephalograms and orthopantographs) were obtained at the initial visit and upon completion of the presurgical orthodontic treatment. Patients with occlusal discrepancies larger than 6 mm and severe palatal scaring underwent Distraction osteogenesis (DO) to advance the maxilla. Patients with an occlusal discrepancy of 6 mm or less, underwent traditional orthognathic surgery including le fort I advancement and Bilateral sagittal split osteotomy (BSSO) to seat the mandible in occlusion. Results: Five patients underwent orthognathic surgery. Two of them underwent double jaw surgery. Three underwent single jaw conventional le fort l advancement. Four patients required bone grafting to repair the residual alveolar defect and to augment the midface deficiency. Nine patients with severe maxillary hypoplasia underwent maxillary advancement using distraction osteogenesis. Conclusion: Patients with a severe maxillary hypoplasia of 6 mm or more and excessive palatal scaring are successfully treated with DO. Conventional le fort I is reserved for patients with less severe maxillary hypoplasia. Both techniques gave promising results providing having followed the proper selection criteria.
KEYWORDS
Cleft Lip and Palate; Hypoplasia; Maxilla; Midface; Class III; RED; Distraction Osteogenesis
Cleft Lip and Palate; Hypoplasia; Maxilla; Midface; Class III; RED; Distraction Osteogenesis
Cite this paper
Alyamani, A. and Abuzinada, S. (2012) A protocol used to manage maxillary hypoplasia in cleft lip and palate patients. Open Journal of Stomatology, 2, 130-135. doi: 10.4236/ojst.2012.22023.
Alyamani, A. and Abuzinada, S. (2012) A protocol used to manage maxillary hypoplasia in cleft lip and palate patients. Open Journal of Stomatology, 2, 130-135. doi: 10.4236/ojst.2012.22023.
References
[1] Thongdee, P. and Samman, N. (2005) Stability of maxillary surgical movement in unilateral cleft lip and palate with preceding alveolar bone grafting. Cleft Palate-Craniofacial Journal, 42, 664-674. doi:10.1597/04-042R.1 [2] McCarthy, J., Schreiber, J., Karp, N., et al. (1992) Len-thening the human mandible by gradual distraction. Plastic and Reconstructive Surgery, 89, 1-10. [3] Polley, J. and Figueroa, A. (1997) Management of severe maxillary deficiency in childhood and adolescence through distraction osteogenesis with an external adjustable rigid distraction device. Journal of Craniofacial Surgery, 8, 181-185. doi:10.1097/00001665-199705000-00008 [4] Rachmiel, A., Aizebud, D., Ardekian, L., et al., (1999) Surgically-assisted orthopaedic protraction of the maxilla in cleft lip and palate patients. International Journal of Oral and Maxillofacial Surgery, 28, 9-14. doi:10.1016/S0901-5027(99)80668-7 [5] Rachmiel, A., (2007) Treatment of maxillary cleft palate: Distraction osteogenesis versus orthognathic surgery— Part one: Maxillary distraction. Journal of Oral and Maxillofacial Surgery, 65,753-757. doi:10.1016/j.joms.2006.08.010 [6] Panula, K., Lorius, B. and Pospisil, O. (1993) The need for orthognathic surgery in patients born with complete cleft palate or complete unilateral cleft lip and palate. Oral Surgery, Oral Diagnosis, 4, 23. [7] Ross, R. (1987) Treatment variables affecting facial growth in complete unilateral cleft lip and palate: An overview of treatment and facial growth. Cleft Palate- Craniofacial Journal, 24, 71-77. [8] Scolozzi, P. (2008) Distraction Osteogenesis in the management of severe maxillary hypoplasia in cleft lip and palate patients. Journal of Craniofacial Surgery, 19, 1199-1214. doi:10.1097/SCS.0b013e318184365d [9] Hochban, W. and Ganss, C. (1993) Austermann KH. Long-term results after maxillary—Advancement in patients with clefts. Cleft Palate-Craniofacial Journal, 30, 237-243. doi:10.1597/1545-1569(1993)030<0237:LTRAMA>2.3.CO;2 [10] Figueroa, A., Polley, J., Friede, H., et al. (2004) Long- term skeletal stability after maxillary advancement with distraction osteogenesis using a rigid external distraction device in cleft maxillary deformities. Plastic and Reconstructive Surgery, 114, 1382-1392. doi:10.1097/01.PRS.0000138593.89303.1B [11] Precious, D. (2007) Treatment of retruded maxilla in cleft lip and palate—Orthognathic surgery versus distraction osteogenesis: The case for orthognathic surgery. Journal of Oral and Maxillofacial Surgery, 65, 758-761. doi:10.1016/j.joms.2006.08.011 [12] Kanno, T., Mitsugi, M., Hosoe, M., Sukegawa, S., et al. (2008) Long-term skeletal stability after maxillary advancement with distraction osteogenesis in non-growing patients. Journal of Oral and Maxillofacial Surgery, 66, 1833-1846. doi:10.1016/j.joms.2007.10.013 [13] Wang, X., Yi, B., et al. (2005) Internal midface distraction in correction of severe maxillary hypoplasia second- dary to cleft lip and palate. Plastic and Reconstructive Surgery, 116, 51-60. doi:10.1097/01.PRS.0000169691.22783.29 [14] Cho, B. and Kyung, H. (2006) Distraction osteogenesis of the hypoplastic midface using a rigid external distraction system: The results of a one to six-year follow-up. Plastic and Reconstructive Surgery, 118, 1201-1212. doi:10.1097/01.prs.0000243563.43421.0b [15] Haers, P., Ge, Z., Locher, M., et al. (1997) Stability of maxillary osteotomies in cleft patients approached by minimal incisions and stabilised by plate osteosynthesis and splint without IMF. In: Lee, S.T., Ed., Transactions of the 8th International Congress on Cleft Palate and Related Craniofacial Anomalies, Stamford Press, Singapore City, 630-634. [16] Cheung, L., Chua, H. and Hagg, M. (2006) Cleft maxillary distraction versus orthognathic surgery: Clinical morbidities and surgical relapse. Plastic and Reconstructive Surgery, 118, 996-1008. doi:10.1097/01.prs.0000232358.31321.ea [17] Kusnoto, B., Figueroa, A. and Polley, J. (2001) Radiographic evaluation of bone formation in the pterygoid region after maxillary distraction with a rigid external distraction (RED) device. Journal of Craniofacial Surgery, 12, 109-117. doi:10.1097/00001665-200103000-00003 [18] Drew, S. (2000) Maxillary advancement with distraction osteogenesis by use of a rigid external distraction device: A 1-year follow-up (Discussion). Journal of Oral and Maxillofacial Surgery, 58, 969. doi:10.1053/joms.2000.8798 [19] Ko, E., Figueroa, A. and Polley, J. (2000) Soft tissue profile changes after maxillary advancement with distraction osteogenesis by use of a rigid external distraction device: A 1-year follow-up. Journal of Oral and Maxillofacial Surgery, 58, 959. doi:10.1053/joms.2000.8735 [20] Freihofer, H. (1977) Change in nasal profile after maxillary advancement advancement in cleft and non-cleft patients. Journal of Maxillofacial Surgery, 5, 20. doi:10.1016/S0301-0503(77)80071-4 [21] Krimmel, M., Cornelius, C., Gulicher, D., et al. (2005) Longitudinal cephalometric analysis after maxillary distraction osteogenesis. Journal of Craniofacial Surgery, 16, 683-688. doi:10.1097/01.scs.0000168779.39969.c1 [22] Van Sickels, J. and Tucker, M. (1990) Management of delayed union and nonunion of maxillary osteotomies. Journal of Oral and Maxillofacial Surgery, 48, 1039-1044. doi:10.1016/0278-2391(90)90285-A [23] He, D., Genecov, D. and Barcelo, R. (2010) Nonunion of the external maxillary distraction in cleft lip and palate: analysis of possible reasons. Journal of Oral and Maxillofacial Surgery, 68, 2402-2411. doi:10.1016/j.joms.2009.09.018
[1] Thongdee, P. and Samman, N. (2005) Stability of maxillary surgical movement in unilateral cleft lip and palate with preceding alveolar bone grafting. Cleft Palate-Craniofacial Journal, 42, 664-674. doi:10.1597/04-042R.1 [2] McCarthy, J., Schreiber, J., Karp, N., et al. (1992) Len-thening the human mandible by gradual distraction. Plastic and Reconstructive Surgery, 89, 1-10. [3] Polley, J. and Figueroa, A. (1997) Management of severe maxillary deficiency in childhood and adolescence through distraction osteogenesis with an external adjustable rigid distraction device. Journal of Craniofacial Surgery, 8, 181-185. doi:10.1097/00001665-199705000-00008 [4] Rachmiel, A., Aizebud, D., Ardekian, L., et al., (1999) Surgically-assisted orthopaedic protraction of the maxilla in cleft lip and palate patients. International Journal of Oral and Maxillofacial Surgery, 28, 9-14. doi:10.1016/S0901-5027(99)80668-7 [5] Rachmiel, A., (2007) Treatment of maxillary cleft palate: Distraction osteogenesis versus orthognathic surgery— Part one: Maxillary distraction. Journal of Oral and Maxillofacial Surgery, 65,753-757. doi:10.1016/j.joms.2006.08.010 [6] Panula, K., Lorius, B. and Pospisil, O. (1993) The need for orthognathic surgery in patients born with complete cleft palate or complete unilateral cleft lip and palate. Oral Surgery, Oral Diagnosis, 4, 23. [7] Ross, R. (1987) Treatment variables affecting facial growth in complete unilateral cleft lip and palate: An overview of treatment and facial growth. Cleft Palate- Craniofacial Journal, 24, 71-77. [8] Scolozzi, P. (2008) Distraction Osteogenesis in the management of severe maxillary hypoplasia in cleft lip and palate patients. Journal of Craniofacial Surgery, 19, 1199-1214. doi:10.1097/SCS.0b013e318184365d [9] Hochban, W. and Ganss, C. (1993) Austermann KH. Long-term results after maxillary—Advancement in patients with clefts. Cleft Palate-Craniofacial Journal, 30, 237-243. doi:10.1597/1545-1569(1993)030<0237:LTRAMA>2.3.CO;2 [10] Figueroa, A., Polley, J., Friede, H., et al. (2004) Long- term skeletal stability after maxillary advancement with distraction osteogenesis using a rigid external distraction device in cleft maxillary deformities. Plastic and Reconstructive Surgery, 114, 1382-1392. doi:10.1097/01.PRS.0000138593.89303.1B [11] Precious, D. (2007) Treatment of retruded maxilla in cleft lip and palate—Orthognathic surgery versus distraction osteogenesis: The case for orthognathic surgery. Journal of Oral and Maxillofacial Surgery, 65, 758-761. doi:10.1016/j.joms.2006.08.011 [12] Kanno, T., Mitsugi, M., Hosoe, M., Sukegawa, S., et al. (2008) Long-term skeletal stability after maxillary advancement with distraction osteogenesis in non-growing patients. Journal of Oral and Maxillofacial Surgery, 66, 1833-1846. doi:10.1016/j.joms.2007.10.013 [13] Wang, X., Yi, B., et al. (2005) Internal midface distraction in correction of severe maxillary hypoplasia second- dary to cleft lip and palate. Plastic and Reconstructive Surgery, 116, 51-60. doi:10.1097/01.PRS.0000169691.22783.29 [14] Cho, B. and Kyung, H. (2006) Distraction osteogenesis of the hypoplastic midface using a rigid external distraction system: The results of a one to six-year follow-up. Plastic and Reconstructive Surgery, 118, 1201-1212. doi:10.1097/01.prs.0000243563.43421.0b [15] Haers, P., Ge, Z., Locher, M., et al. (1997) Stability of maxillary osteotomies in cleft patients approached by minimal incisions and stabilised by plate osteosynthesis and splint without IMF. In: Lee, S.T., Ed., Transactions of the 8th International Congress on Cleft Palate and Related Craniofacial Anomalies, Stamford Press, Singapore City, 630-634. [16] Cheung, L., Chua, H. and Hagg, M. (2006) Cleft maxillary distraction versus orthognathic surgery: Clinical morbidities and surgical relapse. Plastic and Reconstructive Surgery, 118, 996-1008. doi:10.1097/01.prs.0000232358.31321.ea [17] Kusnoto, B., Figueroa, A. and Polley, J. (2001) Radiographic evaluation of bone formation in the pterygoid region after maxillary distraction with a rigid external distraction (RED) device. Journal of Craniofacial Surgery, 12, 109-117. doi:10.1097/00001665-200103000-00003 [18] Drew, S. (2000) Maxillary advancement with distraction osteogenesis by use of a rigid external distraction device: A 1-year follow-up (Discussion). Journal of Oral and Maxillofacial Surgery, 58, 969. doi:10.1053/joms.2000.8798 [19] Ko, E., Figueroa, A. and Polley, J. (2000) Soft tissue profile changes after maxillary advancement with distraction osteogenesis by use of a rigid external distraction device: A 1-year follow-up. Journal of Oral and Maxillofacial Surgery, 58, 959. doi:10.1053/joms.2000.8735 [20] Freihofer, H. (1977) Change in nasal profile after maxillary advancement advancement in cleft and non-cleft patients. Journal of Maxillofacial Surgery, 5, 20. doi:10.1016/S0301-0503(77)80071-4 [21] Krimmel, M., Cornelius, C., Gulicher, D., et al. (2005) Longitudinal cephalometric analysis after maxillary distraction osteogenesis. Journal of Craniofacial Surgery, 16, 683-688. doi:10.1097/01.scs.0000168779.39969.c1 [22] Van Sickels, J. and Tucker, M. (1990) Management of delayed union and nonunion of maxillary osteotomies. Journal of Oral and Maxillofacial Surgery, 48, 1039-1044. doi:10.1016/0278-2391(90)90285-A [23] He, D., Genecov, D. and Barcelo, R. (2010) Nonunion of the external maxillary distraction in cleft lip and palate: analysis of possible reasons. Journal of Oral and Maxillofacial Surgery, 68, 2402-2411. doi:10.1016/j.joms.2009.09.018