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Yamagata K, Mohri T, Watanabe A, Bukawa M, Uchida F, Fukuzawa S, Ishibashi-Kanno N, Bukawa H. Anterior Maxillary Distraction Osteogenesis With Bone-borne Intraoral Buccal Devices for Maxillary Hypoplasia With Cleft Lip and Palate. J Craniofac Surg 2023; 34:1867-1871. [PMID: 37253151 DOI: 10.1097/scs.0000000000009412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 03/20/2023] [Indexed: 06/01/2023] Open
Abstract
Anterior maxillary distraction osteogenesis (AMDO) surgery for cleft lip and palate involves distraction of a segment of the anterior maxilla and advancement using 2 intraoral buccal bone-borne distraction devices. The anterior part of the maxilla is advanced anteriorly with less relapse which increases maxillary length and does not affect speech. We aimed to evaluate the effects of AMDO, including lateral cephalometric changes. Seventeen patients who had undergone this procedure were included in this retrospective study. The distractors were activated by 0.5 mm twice a day after a 3-day latency period. Lateral cephalometric radiographs were evaluated preoperatively, after distraction and removal of distractors, which were compared using the paired Student's t test. Anterior maxillary advancement was obtained in all patients with a median of 8.0 mm. Complications included nasal bleeding and loosening of distractors; however, there was no tooth damage or abnormal movement. The mean sella-nasion-A point (SNA) angle increased significantly, from 74.91° to 79.66°, the A point-nasion-B point angle from -0.38° to 4.34°, and the perpendicular line from nasion to Frankfort Horizontal (NV)-A point from -5.11 to 0.08 mm. The mean anterior nasal spine-posterior nasal spine length increased significantly from 50.74 to 55.10 mm, and the NV-Nose Tip from 23.59 to 26.27 mm. The mean relapse rate of NV-A was 11.1%. AMDO with bone-borne distractor resulted in less relapse and effectively corrected the maxillary retrusion.
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Affiliation(s)
- Kenji Yamagata
- Department of Oral and Maxillofacial Surgery, Institute of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
| | - Tamaki Mohri
- Mohri Orthodontic Office, 2-2-7 Kasuga, Tsukuba, Ibaraki, 305-0821, Japan
| | - Atsushi Watanabe
- Mohri Orthodontic Office, 2-2-7 Kasuga, Tsukuba, Ibaraki, 305-0821, Japan
| | - Moeka Bukawa
- Department of Oral and Maxillofacial Surgery, Institute of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
| | - Fumihiko Uchida
- Department of Oral and Maxillofacial Surgery, Institute of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
| | - Satoshi Fukuzawa
- Department of Oral and Maxillofacial Surgery, Institute of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
| | - Naomi Ishibashi-Kanno
- Department of Oral and Maxillofacial Surgery, Institute of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
| | - Hiroki Bukawa
- Department of Oral and Maxillofacial Surgery, Institute of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
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Gosla Reddy S, Bansal A, Sharma N, Chug A. Modified anterior maxillary distraction using "Winged Osteotomy": A technical note. J Oral Biol Craniofac Res 2021; 11:435-437. [PMID: 34094843 DOI: 10.1016/j.jobcr.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/02/2021] [Accepted: 05/04/2021] [Indexed: 11/28/2022] Open
Abstract
Hypoplasia of the maxilla is common in cleft lip and palate (CLP) deformities. Orthognathic surgery has been the traditional method of correction in such developmental anomalies since 1970's, with Le-Fort I advancement as its long-established management modality, which results in significant speech alteration and relapse rate. In contrast, anterior maxillary distraction (AMD) has the advantage of lesser chances of relapse, velopharyngeal insufficiency, and alteration of speech. This modified AMD technique carries a handful of its advantages as it is an easier procedure compared to the Le-Fort I osteotomy as it gives positive soft tissue changes by improving the projection of the nose and the upper lip, normalizes naso-labial angle, and changes the facial prominence from concave to convex simultaneously as it gives nasolabial and sub-malar prominence post-operatively due to the extension of horizontal cuts up to to the zygomatic region, leading to lesser complications. Also, the hollowing caused by the conventional AMD osteotomy cuts is eliminated by the extension of the winged osteotomy.
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Affiliation(s)
- Srinivas Gosla Reddy
- Department of Dentistry (Cranio-maxillofacial Surgery), AIIMS Rishikesh, Uttarakhand, 249203. India
| | - Adity Bansal
- Department of Dentistry (Cranio-maxillofacial Surgery), AIIMS Rishikesh, Uttarakhand, 249203. India
| | - Nisha Sharma
- GSR Institute of Craniomaxillofacial and Facial Plastic Surgery, Vinay Nagar Colony, Saroor Nagar West, Saidabad, Saroornagar, Telangana, Hyderabad, 500059. India
| | - Ashi Chug
- Department of Dentistry (Cranio-maxillofacial Surgery), AIIMS Rishikesh, Uttarakhand, 249203. India
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Skeletal stability in patients with clefts after large maxillary advancements using intraoral distraction. Br J Oral Maxillofac Surg 2020; 58:663-668. [PMID: 32439215 DOI: 10.1016/j.bjoms.2020.03.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 03/25/2020] [Indexed: 11/22/2022]
Abstract
Maxillary hypoplasia is a common outcome in patients with cleft lip and palate after surgical and orthodontic interventions, and maxillary distraction osteogenesis has become a useful procedure for patients with extensive maxillary deformities. The aim of this study was to evaluate long term (two years) stability after maxillary advancement of more than 10mm by distraction osteogenesis in cleft patients using internal devices. We organised a retrospective study on 42 patients with cleft lip and palate using cephalometric analysis before and after maxillary distraction osteogenesis and evaluated them for 24 months. Postoperative measurements showed a marked advancement with an increase of 13.3mm and 10.8° in the length of the maxilla (Co-A) and SNA, respectively, including a shift from Angle class III to class I in dental relations. Follow-up observations showed preservation of maxillary length with a relapse of only 6.0 % (mean (SD) 0.8 (0.7) mm) and 10% relapse in SNA angle (mean (SD)1.1 (1.4) °) one year postoperatively and a negligible regression at the two years' follow up. This large-scale study shows stable results of skeletal advancement using distraction osteogenesis, indicating safe and reliable outcomes among patients with cleft lip and palate.
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Richardson S, Sinai Khandeparker RV. A retrospective analysis of complications associated with tooth-borne anterior maxillary distraction for managing cleft maxillary hypoplasia: A 12-year experience. J Craniomaxillofac Surg 2020; 48:365-375. [DOI: 10.1016/j.jcms.2020.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 11/25/2019] [Accepted: 02/14/2020] [Indexed: 10/24/2022] Open
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Richardson S, Selvaraj D, Khandeparker RV, Seelan NS, Richardson S. Tooth-Borne Anterior Maxillary Distraction for Cleft Maxillary Hypoplasia: Our Experience With 147 Patients. J Oral Maxillofac Surg 2016; 74:2504.e1-2504.e14. [DOI: 10.1016/j.joms.2016.08.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 07/22/2016] [Accepted: 08/23/2016] [Indexed: 10/21/2022]
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Richardson S, Seelan NS, Selvaraj D, Khandeparker RV, Gnanamony S. Perceptual Speech Assessment After Anterior Maxillary Distraction in Patients With Cleft Maxillary Hypoplasia. J Oral Maxillofac Surg 2016; 74:1239.e1-9. [DOI: 10.1016/j.joms.2016.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 02/11/2016] [Accepted: 02/11/2016] [Indexed: 10/22/2022]
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