Application of asymmetric trans-sutural distraction osteogenesis for severe midfacial hypoplasia in growing patients with unilateral cleft lip and palate
10.3760/cma.j.cn114453-20210224-00080
- VernacularTitle:非对称性经缝牵引成骨术在青少年单侧唇腭裂严重面中部骨骼发育不全中的应用
- Author:
Haizhou TONG
1
;
Yilue ZHENG
;
Xiaomei SUN
;
Ningbei YIN
;
Tao SONG
;
Zhenmin ZHAO
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，北京 100144
- Keywords:
Cleft lip;
Cleft palate;
Midfacial hypoplasia
- From:
Chinese Journal of Plastic Surgery
2022;38(1):9-16
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the effects of asymmetric trans-sutural distraction osteogenesis for severe midfacial hypoplasia in growing patients with unilateral cleft lip and palate.Methods:All the growing patients with unilateral cleft lip and palate combining severe midfacial hypoplasia treated with asymmetric trans-sutural distraction osteogenesis from January 2011 to December 2020 in the Plastic Surgery Hospital, Chinese Academy of Medical Sciences were analyzed retrospectively. The distraction system consisted of the bone-borne traction hooks, nickel-titanium shape memory alloy spring and rigid external distractor. Asymmtric distraction could be achieved by exerting different traction force to bilateral maxilla. The technique for relapse prevention included moderate overcorrection, prompt orthodontic treatment and face mask therapy. The changes of midfacial symmetry between the cleft and non-cleft side were analyzed by comparing the distance of subspinale A-point(A), intersection of lateral border of piriform aperture and plane parallel to midsagittal reference plane(LPA), most inferior point on nasomaxillary suture(INM) and most inferior point on profile of pterygomaxillary suture(PTM) to coronal reference plane between preoperative and postoperative, and the asymmetric ratio of LPA, INM and PTM were calculated.Results:A total of 38 patients, (34 males and 4 females, aged from 8-15 years) were included. All of the patients completed the distraction and achieved a satisfied improvement in the midface convexity and overjet. The postoperative 1-3 years follow-up showed the midface protrusion and occlusal overcoverage after distraction caused by overcorrection tended to become harmonious in the following 6 to 12 months, and 3 patients with no face mask therapy done had relapse on maxilla in various degrees after 3 years follow-up. The measurement findings of 25 patients showed the average advancement of A point was (12.67±4.62) mm(range, 6.21-23.28 mm). The distances of INM, LPA and PTM to CR plane on the cleft side were significantly less than that on the non-cleft side before the distraction( P<0.05). However, after the distraction, these distance differences of INM and PTM between the cleft and non-cleft side were eliminated ( P>0.05). The distance difference of bilateral LPA was reduced, but still significant less on the cleft side( P<0.05). Compared before and after distraction, the asymmetric rate of INM, LPA and PTM was significantly decreased( P<0.05). Conclusions:Asymmetric trans-sutural distraction osteogenesis offers an effective method for the early treatment of severe midfacial hypoplasia in growing patients with unilateral cleft lip and palate, and restores the midfacial symmetry.
