title: Special distraction osteogenesis before bone grafting for alveolar cleft defects to correct maxillary deformities in patients with bilateral cleft lips and palates: distraction osteogenesis performed separately for each bone segment.
abstract: BACKGROUND
  Patients with bilateral cleft lips and palates have premaxillary protrusion and characteristic jaw deformities involving three-dimensional malposition of the premaxilla and bilateral maxillary bone segments. This study examined patients with bilateral cleft lips and palates who had deviation and hypoplasia of the premaxillas and bilateral maxillary segments. Before bone grafting, the patients were treated with special distraction performed separately for each bone segment using a halo-type external device. This report describes this novel treatment method which produced good results.
  
  
  METHODS
  The subjects were five patients with severe jaw deformities due to bilateral cleft lip and palate. They were treated with maxillary Le Fort I osteotomy and subsequent distraction performed separately for each bone segment using a halo device. In three of five patients, premaxillary osteotomy was not performed, and osteotomy and distraction were performed only for the right and left lateral segments with severe hypoplasia.
  
  
  RESULTS
  All patients achieved distraction close to the desired amount. The widths of the alveolar clefts were narrowed, and satisfactory occlusion and maxillary arch form were achieved. After the surgery, three of five patients underwent bone grafting for bilateral alveolar cleft defects and the bone graft survival was satisfactory.
  
  
  CONCLUSIONS
  This method had many benefits, including narrowing of alveolar clefts, improvement of maxillary hypoplasia, and achievement of a good maxillary arch form. In addition, subsequent bone grafting for alveolar cleft defects was beneficial, dental prostheses were unnecessary, and frequency of surgery and surgical invasiveness were reduced. This method is a good surgical procedure that should be considered for patients with bilateral cleft lips and palates who have premaxillary protrusion and hypoplasia of the right and left lateral segments.
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Chiba University, Faculty of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba 260-8670, Japan. Electronic address: nmitsu@air.linkclub.or.jp.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Mitsukawa
authors.affiliation: Department of Plastic and Reconstructive Surgery, St. Mary's Hospital, Fukuoka, Japan.
authors.forename: Atsuomi
authors.initials: A
authors.lastname: Saiga
authors.affiliation: Department of Orthodontics, St. Mary's Hospital, Fukuoka, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Morishita
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Chiba University, Faculty of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba 260-8670, Japan.
authors.forename: Kaneshige
authors.initials: K
authors.lastname: Satoh
mesh_terms: D000293:Adolescent; D064728:Alveolar Bone Grafting / Q000379:methods*; D000539:Alveolar Process / Q000002:abnormalities; D016025:Bone Transplantation / Q000379:methods; D002508:Cephalometry / Q000379:methods; D002971:Cleft Lip / Q000601:surgery*; D002972:Cleft Palate / Q000601:surgery*; D003724:Dental Arch / Q000002:abnormalities / Q000601:surgery; D016267:External Fixators; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D008297:Male; D008310:Malocclusion / Q000601:surgery; D008437:Maxilla / Q000002:abnormalities* / Q000601:surgery; D019857:Osteogenesis, Distraction / Q000295:instrumentation / Q000379:methods*; D019340:Osteotomy, Le Fort / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
keywords: Alveolar cleft closure; Bilateral cleft lip and palate; Distraction osteogenesis; Halo-type external device; Maxillary deformities