Remarkable achievements have been made for lymphocyte infusion of lymphoma and leukemia, especially of lymphoproliferative disease within twenty-first century. The donor lymphocyte infusion or mobilized donor lymphocyte infusion (DLI/DSI) offer an opportunity of second remission for relapse patients post-transplantation. Cytokine-induced killer/DC cytokine-induced killer play an anti-tumor activity beyond non-MHC restricted. Cytotoxic lymphocyte infusion activated by synthetic tumor antigen produces targeted effects of anti-tumor. Transgenic CTL of anti-tumor TCR has brought the dawn in lymphoma and leukemia patients with defective lymphocytes. Maternal lymphocyte infusion play an anti-tumor/viral activity by avoiding the immune barrier of HLA mismatch.

OBJECTIVETo classify the patients with cleft lip and palate who need orthognathic surgery and to propose the corresponding operations.

METHODSFrom January 2005 to May 2015, 121 patients with cleft lip and palate diagnosed as maxillary retrusion were treated by orthognathic surgery. Inclusion criteriar: (1) male aged over 16, female aged over 14; (2) diagnosed as non-syndromic cleft lip and palate without systemic disease and other genetic diseases; (3) without previous orthodontic and orthognathic treatment; (4) having no other craniofacial malformation. Maxillary features and repaired types were recorded.

RESULTS93 patients were included and divided into two categories depended on the dental crowding. Class I: the teeth quantity and bone quantity is coordinated, space analysis ≤ 4 mm (mild dental crowding). The forward distance of maxillary less than 6 mm was defined as Class I a (36 cases) more than 6 mm as Class I b (28 cases). Class II: the teeth quantity and bone quantity is not coordinated, space analysis > 4 mm ( moderate or severe dental crowding). After the simulation of distraction osteogenesis, the anterior crossbite was corrected defined as Class II a (23 cases), not corrected defined as Class II b (6 cases). Class I a were corrected by conventional orthognathic surgery. While Class I b were corrected by Le Fort I maxillary advancement using distraction osteogenesis. Class II a were repaired just by anterior maxillary distraction. While Class II b need to combine conventional orthognathic surgery with anterior maxillary distraction. All the patients were satisfied with the treatment effect.

CONCLUSIONSThe patients of cleft lip and palate with maxillary retrusion who need orthognathic surgery can be classified as the method mentioned above, and then choose the appropriate operations.

Adolescent ; Adult ; Cleft Lip ; complications ; Cleft Palate ; complications ; Female ; Humans ; Male ; Maxilla ; Osteogenesis, Distraction ; Osteotomy, Le Fort ; Retrognathia ; classification ; surgery

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.

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.

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.

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.

BACKGROUNDMaxillary anterior segmental distraction osteogenesis (MASDO) is a recently used method for correction of severe maxillary retrusion in cleft lip and palate (CLP) patients. In this article, we evaluated the feasibility of MASDO using rigid external distraction (RED) and rapid orthodontic tooth movement to correct severe maxillary retrusion in CLP patients.

METHODSFourteen male and five female complete CLP patients between the ages of 18 and 22 years (mean age 19.7 years) at the time of distraction, with severe maxillary retrusion, were treated with the rigid external distraction (RED) device after maxillary anterior osteotomy. Rapid orthodontic tooth movement was started one week after the MASDO. Standard profile photographic, cephalometric films were obtained preoperatively and after therapy. Sella-nasion-point A (SNA) and Sella-nasion-point B (SNB) angles were measured to reflect changes in maxillary and mandibular position, and the distance between anterior nasal spine and posterior nasal spine (ANS-PNS) was measured to represent the maxillary dental arch length.

RESULTSThe SNA angle increased from an average of 74.6° (range 73.0°-78.0°), preoperatively, to 83.4° (range 78.6°-88.0°) after the RED was removed (P < 0.01). All cases of severe maxillary retrusion were improved. Nine patients' profiles became harmonious after therapy. One patient had a bimaxillary protrusion deformity and needed further surgery. The regenerate alveolar crest and edentulous space on both segments was almost completely eliminated after rapid orthodontic tooth movement.

CONCLUSIONMASDO with the RED system and rapid orthodontic tooth movement is a successful way of correcting severe maxillary retrusion in CLP patients.

Adolescent ; Adult ; Cleft Lip ; surgery ; Cleft Palate ; surgery ; Female ; Humans ; Male ; Osteogenesis, Distraction ; methods ; Tooth Movement Techniques ; Young Adult