Maxillary Distraction: Aesthetic and Functional Benefits in Cleft Lip-Palate and Prognathic Patients during Mixed Dentition

Abstract

In the last few years, distraction techniques have been used successfully to correct the hypoplastic human mandible. In patients with cleft lip and palate, normal growth of the maxilla may be impaired by early cleft repair, and many of them do not respond to orthodontic procedures alone. Maxillary distraction is an alternative technique to correct maxillary hypoplasia during mixed dentition. In the last 3 years, the procedure was performed in 38 patients aged between 6 and 12 years; 18 patients had unilateral cleft lip and palate, 9 patients had bilateral cleft lip and palate, 7 patients had unilateral cleft palate, 2 patients had prognathism, and 2 patients had nasomaxillary dysplasia. Photographs, posteroanterior and lateral cephalograms, and dental models are obtained preoperatively (as well as an orthopantomogram) to locate the tooth buds. A subperiosteal dissection is performed exposing the anterior and lateral aspects of the maxilla, and an incomplete horizontal osteotomy is done above the tooth buds. Using a facial mask and an intraoral fixed appliance system as an anchorage, we initiate on the fifth postoperative day the application of distraction forces. Maxillary advancement between 4 and 12 mm is achieved during 3 to 4 weeks, and a satisfactory class I or II molar relationship is also obtained. A combination of forward and downward distraction forces can be used to achieve simultaneous advancement and elongation of the hypoplasic maxilla. The aesthetic results are excellent, and the nasolabial angle is increased, including a more anterior projection of the upper lip. Nasal breathing is improved as well as the air flow and patency of the nasal airway. Velopharyngeal function remains unchanged after the procedure. The follow-up in this series varied from 6 months to 3 years. No relapses have been observed.

Success rate of miniplate anchorage for bone anchored maxillary protraction

“…1,2 The main disadvantages of Delaire face mask therapy are noncompliance due to discomfort, dentoalveolar compensation, and clockwise rotation of the mandible. [3][4][5][6] To reduce these side effects, modified methods of maxillary protraction were developed consisting of (1) maxillary distraction by a rigid external distractor [7][8][9][10][11][12] ; (2) maxillary distraction with a face mask after Le Fort I corticotomy in cleft patients [13][14][15] ; and (3) face mask combined with skeletal anchorage in the upper jaw. [16][17][18] The first two modified methods of maxillary protraction involved Le Fort I corticotomy or osteotomy; the two latter protocols still involved the use of a face mask.…”

Treatment of midfacial hypoplasia in syndromic and cleft lip and palate patients by means of a rigid external distractor (RED)

“…Molina et al 18 were the pioneers on the use of DO for maxillary advancement, after incomplete horizontal osteotomy of the maxilla, with the aid of application of reverse traction by means of face mask and rubber bands.…”

Rapid maxillary expansion compared to surgery for assistance in maxillary face mask protraction

“…In the literature this proce- dure is termed distraction, which is defined as a biologic process of new bone formation between surfaces of bone segments that are gradually separated by incremental traction. It has been reported 25 that the advantage of this method is not only its rapidity but also the soft tissue lengthening that occurs during new bone formation, which causes significant changes with less risk of relapse. Distraction osteogenesis has become an important technique in the treatment of maxillary and midfacial hypoplasia.…”

“…Rachmiel and others [19][20][21][22][23][24][25] reported that the values related to the treatment effects of surgically assisted protraction of the maxilla using a FM range from 3 to 12 mm in the very short term, compared to conventional FM therapy. In this study we aimed to compare the treatment results of surgically assisted protraction of the maxilla with FM therapy and the results of RMEassisted FM therapy.…”

“…Molina et al 25 reported 43 cases, all of which involved treatment with this method; these patients were corrected from a Class III skeletal relationship to a Class I relationship, and the maxilla was advanced 5 to 9 mm. Moline et al reported that there was new bone formation at the pterygomaxillary suture and that pretreatment apnea was decreased.…”