The use of internal maxillary distraction for maxillary hypoplasia: a preliminary report.
OBJECTIVE
Distraction osteogenesis is a useful alternative to advance the maxilla in complicated cases of maxillary hypoplasia. The purpose of this article is to review the workup, experience, and preliminary results with the use of internal distraction osteogenesis for maxillary hypoplasia at one teaching institution.


METHODS
Over a 5-year period, more than 300 patients with craniofacial and dentofacial defects have undergone oral and maxillofacial surgery at our center to correct their skeletal discrepancies. Of these, 10 have had maxillary distraction osteogenesis done with internal distractors. Follow-up of 6 months or more was available for 8 patients. Stereolithographic models were used to bend distractors prior to surgery in 6 patients.


RESULTS
Latency prior to the start of distraction was 3 to 7 days and varied with the age of the patient. Distraction occurred at approximately 1 mm per day with an average distraction length of 8.5 mm (range, 6-10 mm). Excellent occlusal results were obtained in 5 patients. Major complications including nonunion and failure to achieve acceptable occlusal results were observed in 3 patients. Minor complications including pain and loosening of the distracter devices were observed in 2 patients, but did not appear to affect the esthetic and functional results.


CONCLUSIONS
Distraction osteogenesis is a useful alternative to traditional orthognathic surgery to treat maxillary hypoplasia. Internal distractions are attractive to patients, but are more difficult to place and can cause discomfort to patients when trying to achieve an ideal primary vector of distraction. Stereolithographic models can help with placement of the device. Changes in design of distractors may help with patient discomfort.
Van Sickels
Joseph E
JE
Department of Oral and Maxillofacial Surgery, College of Dentistry, Chandler Medical Center, University of Kentucky, Lexington, KY 40536-0297, USA. vansick@email.uky.edu
Madsen
Mathew J
MJ
Cunningham
Larry L
LL
Bird
Douglas
D
D000293:Adolescent; D000328:Adult; D002648:Child; D002972:Cleft Palate / Q000601:surgery; D006801:Humans; D016268:Internal Fixators; D008437:Maxilla / Q000601:surgery*; D008844:Micrognathism / Q000601:surgery*; D019647:Oral Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D019857:Osteogenesis, Distraction / Q000009:adverse effects / Q000295:instrumentation*; D010149:Postoperative Pain / Q000209:etiology; D016896:Treatment Outcome