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

Discussion

The method presented is based on an incomplete Le Fort I osteotomy without down fracturing the maxilla. The posterior part of the uncut maxillary sinus maintains the maxilla in the original position obviating the need for mini plate fixation. Complete osseous fracture at the pterygomaxillary fissure, however, is recommended to facilitate the forward movement of the maxilla and new bone formation at this site. In all of our patients, the retruded maxilla was advanced using the principles of distraction osteogenesis. There was a marked forward movement of the maxilla with correction of the negative overjet and minor increase in vertical dimension of the jaws due to the associated slight downward movement of the maxilla. This resulted in a more posterior position of the mandible and improved esthetics.

Conclusion

In conclusion, the results of this study demonstrate that rapid maxillary advancement in cleft patients can be achieved successfully. Surgically assisted orthopedic protraction of the maxilla eliminates the need for bone grafting and intermaxillary fixation by plates and screws, which can damage tooth buds or roots. This method is suggested for children and young adolescents. When working with patients in a period of active growth, slight over advancement of the maxilla followed by continual monitoring of maxillary growth is recommended. Long-term stability and further growth of the maxilla after distraction osteogenesis procedures require further investigations.