Evaluation of the modified maxillary distraction osteogenesis for cleft lip and palate with moderate to severe maxillary hypoplasia
10.3760/cma.j.cn114453-20200717-00432
- VernacularTitle:改良上颌骨牵引成骨治疗中重度唇腭裂上颌后缩效果评价
- Author:
Binqing WANG
1
;
Haizhou TONG
;
Junya ZHAI
;
Yilue ZHENG
;
Yang LYU
;
Ningbei YIN
;
Tao SONG
Author Information
1. 中国医学科学院北京协和医学院整形外科医院唇腭裂中心 100144
- Keywords:
Cleft lip;
Cleft palate;
Maxilla;
Osteotomy, Le Fort;
Osteogenesis, distraction;
Maxillary hypoplasia;
Three-dimensional measurement
- From:
Chinese Journal of Plastic Surgery
2021;37(5):467-475
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To present the clinical results and potential complications of modified maxillary distraction osteogenesis in the treatment of moderate to severe maxillary hypoplasia for patients with cleft lip and palate.Methods:All the cases were treated with a modified distraction osteogenesis in the Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from July 2017 to December 2019. A rigid external distraction(RED) with intranasal bone-borne traction hooks was performed after the Le Fort Ⅰ osteotomy and a maxillary internal rigid fixation was done immediately after 3-4 weeks of RED device distraction. Paired-samples t-test was used to analyze the three-dimensional reconstruction and measurements of the patient’s preoperative (T0) and immediate completion of traction (T1) cranial CT maxillofacial bony structures. Results:Fifteen patients (12 males and 3 females, ranging from 14 to 25 years in age) with moderate to severe maxillary hypoplasia were analyzed retrospectively. There were significant differences ( P<0.05) in all measures of maxillary and mandibular morphology at the completion of distraction compared to preoperatively. The mean advancement of A point (subspinale) was (10.69±9.01) mm, and the mean increase in ANB (subspinale-nasion-supramental) was (13.53±7.14)°. The average increase of alveolar plane and mandibular plane was (3.97±5.87)° and (4.65±3.67)° separately. The average growth of anterior facial height was (5.63±4.41) mm. The maxilla moved forward and downward, increasing the midface prominence and improving the facial contour. The traction process had an effect on the position of the mandible, with 5 in 15 patients experiencing moderate to severe decreased mouth opening, and the mouth opening limitation was relieved by mouth opening training after fixation at the end of distraction. One patient experienced temporomandibular joint (TMJ) dislocation, which was relieved by manual repositioning and mouth opening training after maxillary fixation and sagittal split ramus osteotomy. Conclusions:Modified maxillary distraction osteogenesis can effectively advance the maxilla, allowing clockwise rotation of mandible, improving facial contour, and significantly shortening the traction time. Limited mouth opening and TMJ dislocation may occur during traction.
