Maxillary distraction osteogenesis in cleft lip and palate patients with skeletal anchorage.
OBJECTIVE
Maxillary distraction osteogenesis with the rigid external distraction (RED) system has been used to treat cleft lip and palate (CLP) patients with severe maxillary hypoplasia. We introduce maxillary distraction osteogenesis for CLP patients with skeletal anchorage adapted on a stereolithographic model.


METHODS
Six maxillary deficiency CLP patients treated according to our CLP treatment protocol had undergone maxillary distraction osteogenesis.


METHODS
In all patients, computed tomography (CT) images were recorded preoperatively, and the data were transferred to a workstation. Three-dimensional skeletal structures were reconstructed with CT data sets, and a stereolithographic model was produced. On the stereolithographic model, miniplates were adapted to the surface of maxilla beside aperture piriforms. The operation performed involved a high Le Fort I osteotomy with pterygomaxillary disjunction. Miniplates were fixed to the maxillary segment with three or four screws and used for anchorage of the RED system. Retraction of the maxillary segment was initiated after 1 week.


RESULTS
The accuracy of the stereolithographic models was enough to adapt the miniplates so that there was no need to readjust the plates during surgery. Postoperative cephalometric analysis showed that the direction of the retraction was almost parallel to the palatal plane, and dental compensation did not occur.


CONCLUSIONS
We performed maxillary distraction osteogenesis with skeletal anchorage adapted on the stereolithographic models. Excellent esthetic outcome and skeletal advancement were achieved without dentoalveolar compensations.
Minami
Katsuhiro
K
Cleft Lip and Palate Center, University Hospital of Aichi-Gakuin and the Second Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Aichi-Gakuin University, Aichi, Japan. k-minami@c.aichi-gakuin.ac.jp
Mori
Yoshihide
Y
Tae-Geon
Kwon
K
Shimizu
Hidetaka
H
Ohtani
Miyuki
M
Yura
Yoshiaki
Y
D000293:Adolescent; D001860:Bone Plates; D001863:Bone Screws; D002508:Cephalometry; D002971:Cleft Lip / Q000601:surgery*; D002972:Cleft Palate / Q000601:surgery*; D017076:Computer-Aided Design; D016267:External Fixators; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods; D008297:Male; D008437:Maxilla / Q000002:abnormalities / Q000601:surgery*; D008953:Models, Anatomic; D009300:Nasal Septum / Q000601:surgery; D019857:Osteogenesis, Distraction / Q000295:instrumentation* / Q000379:methods; D019340:Osteotomy, Le Fort / Q000295:instrumentation / Q000379:methods; D010347:Patient Care Planning; D013100:Sphenoid Bone / Q000601:surgery; D036542:Tomography, Spiral Computed / Q000379:methods; D016896:Treatment Outcome