Maxillary Distraction Osteogenesis in the Adolescent Cleft Patient: Three-Dimensional Computed Tomography Analysis of Linear and Volumetric Changes over Five Years

• Published in: The Cleft palate-craniofacial journal Vol. 48; no. 4; pp. 445 - 454
• Main Authors: Kuo-Ting Chen, Philip, Por, Yong-Chen, Jein-Wein Liou, Eric, Chun-Shin Chang, Frank
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01.07.2011; American Cleft Palate-Craniofacial Association; SAGE PUBLICATIONS, INC
• Subjects: Adolescent; Biological and medical sciences; Cell physiology; Cephalometry - methods; Child; Cleft Palate - surgery; Clinical outcomes; Deformities; Dentistry; Female; Follow-Up Studies; Fundamental and applied biological sciences. Psychology; Humans; Image Processing, Computer-Assisted - methods; Imaging, Three-Dimensional - methods; Longitudinal Studies; Male; Malocclusion, Angle Class III - surgery; Mandible - pathology; Maxilla - abnormalities; Maxilla - pathology; Maxilla - surgery; Maxillofacial Development - physiology; Maxillofacial surgery; Medical sciences; Mineralization, calcification; Molecular and cellular biology; Mouth; Nasal Bone - pathology; Osteogenesis, Distraction - methods; Osteotomy, Le Fort - methods; Otorhinolaryngology. Stomatology; Overbite - pathology; Patient Care Planning; Recurrence; Retrospective Studies; Sella Turcica - pathology; Skeleton and joints; Sphenoid Bone - pathology; Teenagers; Three dimensional imaging; Tomography, X-Ray Computed - methods; User-Computer Interface; Vertebrates: osteoarticular system, musculoskeletal system; cleft maxillary distraction; relapse; 3D CT analysis; Human; Volumetric analysis; Relapse; Radiodiagnosis; Stomatology; Maxillary; Congenital cleft; Congenital disease; Malformation; Adolescent; Distraction; Medical imagery; Computerized axial tomography; Osteogenesis
• ISSN: 1055-6656; 1545-1569
• DOI: 10.1597/09-087

Objective To assess the results of maxillary distraction osteogenesis with the Rigid External Distraction System using three-dimensional computed tomography scan volume-rendered images with respect to stability and facial growth at three time frames: preoperative (T0), 1-year postoperative (T1), and 5-years postoperative (T2). Design Retrospective analysis. Setting Tertiary. Patients A total of 12 patients with severe cleft maxillary hypoplasia were treated between June 30, 1997, and July 15, 1998. The mean age at surgery was 11 years 1 month. Interventions Le Fort I maxillary distraction osteogenesis. Distraction was started 2 to 5 days postsurgery at a rate of 1 mm per day. The consolidation period was 3 months. No face mask was used. A paired t test was used for statistical analysis. Main Outcome Measures Overjet, ANB, and SNA and maxillary, pterygoid, and mandibular volumes. Results From T0 to T1, there were statistically significant increments of overjet, ANB, and SNA and maxillary, pterygoid, and mandibular volumes. The T1 to T2 period demonstrated a reduction of overjet (30.07%) and ANB (54.42%). The maxilla showed a stable SNA and a small but statistically significant advancement of the ANS point. There was a significant increase in the mandibular volume. However, there was no significant change in the maxillary and pterygoid volumes. Conclusions Maxillary distraction osteogenesis demonstrated linear and volumetric maxillary growth during the distraction phase without clinically significant continued growth thereafter. Overcorrection is required to take into account recurrence of midface retrusion over the long term.