Bone-borne palatal distraction to correct the constricted cleft maxilla.
BACKGROUND
Transverse maxillary hypoplasia, with or without cleft deformity, is typically treated with orthodontic expansion. However, the management of those patients who present later in life with severe uncorrected deformities or who have failed prior orthodontic care remains controversial. Tooth-borne palatal expanders have limitations in this subset of patients with scarred, constricted cleft palate. In this study, we assess the efficacy and safety of using a bone-borne palatal distraction device as an alternative treatment for this difficult subset of patients.


METHODS
Older children with a constricted maxilla who previously had unilateral or bilateral cleft lip and palate repairs and failed orthodontic expansion were included in the study (n = 15). Patients underwent Le Fort I corticotomy with placement of the bone-borne distraction device, expansion at a rate of 0.5 mm/d, and subsequent alveolar bone grafting. Preoperative and follow-up maxillary impressions were compared with assessed improvements in intermolar distance, intercanine distance, alveolar cleft width, and total palatal area. In addition, a small group of noncleft patients with constricted maxillas was treated with bone-borne palatal distraction without a corticotomy (n = 4).


RESULTS
The mean amount of distraction in all patients was 14.1 mm, with a follow-up period of 19 months (range, 8-30 months). The average increase in intermolar distance was 8.4 mm, intercanine distance increased by an average of 9.5 mm, and palate surface areas were increased by a mean of 28.9 mm2. Relapse was between 4% and 7%, and all patients underwent subsequent alveolar bone grafting. In addition, the noncleft patients successfully underwent bone-borne palatal distraction without a corticotomy, with a 4% to 5% relapse.


CONCLUSIONS
Rapid palatal expansion using a bone-borne distraction device in cleft patients with transverse maxillary hypoplasia who have failed nonsurgical orthodontic expansion provides adequate expansion necessary for alveolar bone grafting and stable results.
Vyas
Raj M
RM
Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, School of Medicine, Los Angeles, California 90095-6960, USA.
Jarrahy
Reza
R
Sisodia
Manisha
M
Jourabchi
Natanel
N
Wasson
Kristy L
KL
Bradley
James P
JP
D000293:Adolescent; D000328:Adult; D000543:Alveoloplasty / Q000379:methods; D016025:Bone Transplantation / Q000379:methods; D002508:Cephalometry; D002648:Child; D002972:Cleft Palate / Q000601:surgery*; D003481:Cuspid / Q000473:pathology; D003724:Dental Arch / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008437:Maxilla / Q000002:abnormalities* / Q000473:pathology / Q000601:surgery; D003765:Models, Dental; D008963:Molar / Q000473:pathology; D019857:Osteogenesis, Distraction / Q000295:instrumentation / Q000379:methods*; D019340:Osteotomy, Le Fort / Q000379:methods; D010155:Palatal Expansion Technique / Q000295:instrumentation; D010159:Palate / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult