Midface Osteodistraction: Cleft Patients
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Adi Rachmiel, DMD, Dror Aizenbud, DMD, MSc, Micha Peled, DMD, MD, Dov Laufer, DMD

Introduction

Maxillary retrusion is a common feature in cleft lip and palate patients due to early surgical intervention on the lip and palate, often leading to impairment of maxillary growth (Bardach & Salyer, 1991; Ross, 1987). Ross showed that about 25% of patients with unilateral cleft lip and palate develop maxillary hypoplasia that do not respond to orthodontic treatment alone. The hypoplasic maxilla is usually advanced at a later date by a Le Fort I osteotomy with or without a bone graft. However, it is often difficult to mobilize the maxilla in these patients due to the scar tissue resulting from previous operations. In spite of improvements in surgical techniques and bone segment fixation, there is a greater tendency for relapse in cleft patients when compared to non-cleft patients with maxillary hypoplasia (Obwegeser, 1969; Houston et al., 1989; Posnick & Dagys, 1991; Adlam & Banks, 1989). In young growing patients, attempts are usually made to treat malocclusions with the use of maxillary protraction devices and chin cups in order to promote forward growth of the retruded maxilla. The duration of this treatment, however, is often more than one year and produces only slight anterior movement of the maxilla (Ishii et al., 1987; Tindlund et al., 1993).

The purpose of this study was to investigate a new treatment approach, which combines surgical and orthopedic protraction methods based on the principle of distraction osteogenesis that was developed and popularized by Ilizarov in the early 1950’s (Ilizarov, 1989a, 1989b). Recent animal studies demonstrated that this method could be applied successfully to elongate the membranous bones of the midface (Rachmiel et al., 1993, 1995, 1996). Based on these experimental results, we began a clinical study where surgically assisted orthopedic protraction of the maxilla was used to improve the facial appearance and occlusion, as well as to promote bone growth. The procedure can be applied as soon as the maxillary skeletal retrusion appears during childhood or early adolescence.