J Korean Assoc Maxillofac Plast Reconstr Surg.  2009 Jan;31(1):53-60.

Treatment of midface deficiency on adult cleft lip and palate individuals by distraction osteogenesis: Case report

Affiliations
  • 1Department of Orthodontics, School of Dentistry, Pusan National University, Busan, Korea. jorkim@pusan.ac.kr
  • 2Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, Busan, Korea.

Abstract

Maxillary deficiency, anterior cross bite, constriction of maxillary arch, malaligned teeth are frequently observed in patients with cleft lip and palate. Surgery and orthodontics, combined intervention are needed to correct maxillary deficiency. Distraction osteogenesis that currently used has many advantages like less relapse tendency, more advancement of maxilla, capable in growing patients. In case 1, 18 years old girl with BCLP had severe midfacial deficiency and multiple missing of teeth. LeFort I osteotomy, followed by maxillary distraction osteogenesis utilizing rigid external distraction device(RED) system, was performed. After a 6-day latency period, distraction proceeded at a rate of 1mm per day (at 1st week, 1.5mm/day). Total advancement was 19mm. The RED device left in place for the additional 4 weeks for consolidation. After the RED device was removed, face mask was applied with elastic traction for 5 weeks. After achieving acceptable facial appearance and occlusion, orthodontic appliance was removed. The results after 4 years follow-up was sustained pretty well without aggravation of velopharyngeal function. In case 2, 22 years old man with UCLP had severe midfacial deficiency and palatally erupted upper 2nd premolars due to arch length discrepancy, but the anterior segment of maxillary did not show constriction and crowding. patient had no arch width discrepancy, crowding was concentrated on premolar region. Segmental LeFort I osteotomy was performed. After a 6 - day latency period, using internal distraction device, distraction proceeded at a 0.5mm per day(at 1st week, 0.75 - 1 mm/day). Total advancement was 15mm. After internal distraction device was removed, face mask was applied with elastic traction for 4 weeks. After surgicalorthodontic treatment, facial appearance and occlusion was improved pretty good, and after 46 months follow- up the result was retained well.

Keyword

Cleft lip and palate; Extraoral/Internal distraction osteogenesis

MeSH Terms

Adult
Bicuspid
Cleft Lip
Constriction
Crowding
Follow-Up Studies
Humans
Hypogonadism
Latency Period (Psychology)
Malocclusion
Masks
Maxilla
Mitochondrial Diseases
Ophthalmoplegia
Orthodontic Appliances
Orthodontics
Osteogenesis, Distraction
Osteotomy
Palate
Recurrence
Tooth
Traction
Hypogonadism
Mitochondrial Diseases
Ophthalmoplegia
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