Is Le Fort I Distraction Enough to Treat Severe Midface Hypoplasia?

Abstract

Background: In severe cases of maxillary hypoplasia, Le Fort I distraction may be required for treatment. This study describes our experience with internal distraction devices and assesses our outcomes in patients with a negative overjet on average >15 mm. Methods: A retrospective review of patients with a history of cleft lip and/or palate who underwent Le Fort I distraction at our institution from 11/2007-11/2017 was performed. Data regarding demographics, procedural details and outcomes were collected and analyzed.Results: Twenty patients, 13 (65.0%) male and 7 (30.0%) female, were included. All (100%) patients had a history of cleft lip and/or palate and 2 (10.0%) of them had associated syndromes. All 20 patients underwent internal distraction. The average age at surgery was 17.8 years (range 15.2-20.7, SD 1.6 years). The average preoperative negative overjet was 19.27 mm (range 10-30, SD 5.63 mm). The mean total distraction length was 15.3 mm (range 0-30, SD 6.72 mm). There were no intraoperative complications, however, there were a total of 4 (20.0%) postoperative complications, 2 of which required reoperation due to device malfunction or displacement. 14 (70.0%) patients had repeat procedures to complete occlusal correction or correct relapse. Conclusions: Maxillary distraction alone was insufficient for correction of maxillary discrepancies averaging >15 mm. Instead, it's utility may be in positioning the maxilla for a more viable final advancement and fixation procedure, rather than being solely responsible for achieving normal occlusion during distraction.

Does the Rigid External Distraction Device Alter Maxillary Pitch in Cleft Maxillary Distraction?

“…22,35 Others report settling for an improved but suboptimal positioning of the maxillary with the intention of coming back at a future date to definitively correct the deformity. 21…”

“…[17][18][19] Advocates of RED over internal distraction purport the ability of the device to achieve multi-vector corrections. 8,[18][19][20][21][22][23] Limited data exists to examine the success of the RED system to three-dimensionally control the maxilla during the process. 15,[24][25][26] The purpose of this study is to assess vector control in cleft patients treated with RED by evaluating maxillary pitch changes before and after distraction.…”

Behandlung extremer maxillärer Retrognathien

“…unzureichende knöcherne Überlagerungsflächen gesetzt sind, überbrückt die Distraktion auch weitere Distanzen. Im Mittelgesichtsbereich/Oberkiefer wurden kürzlich komplikationslose Distraktionen bis zu 30 mm beschrieben [3]. In der Regel wird die Distraktion des gesamten Oberkiefers bzw.…”

“…In vielen Fällen sind nach Abschluss der Distraktion noch Korrektureingriffe erforderlich, um die gewünschte Zielposition und Zielokklusion zu erreichen. Goel und Kollegen 3 beschreiben, dass in 70% der behandelten Patienten Folgeeingriffe erforderlich waren, um letztendlich das gewünschte Ergebnis zu erreichen.…”

Sequential Treatment of Extreme Maxillary Hypoplasia: A Historical Patient Report of an Edentulous Adult Patient With Ankyloglossia

“…Treatment of severe maxillary hypoplasia for patients with a history of cleft was described recently by Goel et al 9 with the use of internal distraction device. It was to correct high sagittal discrepancies (negative overjet >15 mm).…”