title: Three-dimensional quantitative evaluation of midfacial skeletal changes after trans-sutural distraction osteogenesis for midfacial hypoplasia in growing patients with cleft lip and palate.
abstract: OBJECTIVE
  Trans-sutural distraction osteogenesis (TSDO) is an alternative method for the early treatment of midfacial hypoplasia in growing patients with cleft lip and palate (CLP). The purpose of this study was to analyze three-dimensional (3D) midfacial skeletal changes after TSDO and to explore the mechanism in this process.
  
  
  METHODS
  All patients with nonsyndromic CLP who underwent bone-borne TSDO for midfacial hypoplasia from 2005 to 2014 were reviewed in this retrospective study. 3D morphological and quantitative measurement analyses were performed to evaluate midfacial skeletal changes by superimposition of preoperative and postoperative computed tomographic images.
  
  
  RESULTS
  Twenty-six patients with mean age of 11.5 years met the inclusion criteria. The 3D morphological findings exhibited the most significant suture stress changes at the pterygomaxillary suture area, with obvious bone generation in all patients. The whole midfacial skeleton had progressively increased advancement in a craniocaudal direction along the midface segment, associated with morphological changes in skeleton itself. The 3D quantitative measurement findings showed differential advancement of each landmark at the maxillary alveolar, zygomatic bone, orbital rim, and nasal bone, which was consistent with morphological findings.
  
  
  CONCLUSIONS
  TSDO allows rotation advancement of the midfacial skeleton to achieve occlusal correction and facial harmony through the mechanism of both suture remodeling and bone remodeling.
authors.affiliation: Department of Cleft Lip and Palate, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
authors.forename: Haizhou
authors.initials: H
authors.lastname: Tong
authors.affiliation: Department of Cleft Lip and Palate, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Gao
authors.affiliation: Department of Cleft Lip and Palate, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
authors.forename: Jiapeng
authors.initials: J
authors.lastname: Yin
authors.affiliation: Department of Cleft Lip and Palate, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
authors.forename: Zehong
authors.initials: Z
authors.lastname: Shi
authors.affiliation: Department of Cleft Lip and Palate, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Song
authors.affiliation: Department of Cleft Lip and Palate, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
authors.forename: Haidong
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Cleft Lip and Palate, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
authors.forename: Xiaomei
authors.initials: X
authors.lastname: Sun
authors.affiliation: Department of Cleft Lip and Palate, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
authors.forename: Yongqian
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Cleft Lip and Palate, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
authors.forename: Ningbei
authors.initials: N
authors.lastname: Yin
authors.affiliation: Department of Cleft Lip and Palate, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Electronic address: mjzhao46@126.com.
authors.forename: Zhenmin
authors.initials: Z
authors.lastname: Zhao
mesh_terms: D000293:Adolescent; D002648:Child; D002971:Cleft Lip / Q000503:physiopathology*; D002972:Cleft Palate / Q000503:physiopathology*; D005147:Facial Bones / Q000000981:diagnostic imaging* / Q000254:growth & development / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D019857:Osteogenesis, Distraction / Q000379:methods; D012189:Retrospective Studies; D013537:Sutures; D016896:Treatment Outcome
keywords: Cleft lip; Cleft palate; Distraction osteogenesis; Midfacial hypoplasia; Trans-sutural