Introduction: Cleft lip and palate patients can present with a maxillary retrusion with tendency to Class III malocclusion after cleft repair. Within the last few years dististraction osteogenesis has been used as an alternative to maxillary osteotomies and bone grafting in cleft palate maxillary hypoplasia. Aim: This paper presents our experience in using external and internal devices for correction of midface hypoplasia and analyses long-term stability of skeletal and soft tissue changes after maxillary advancement with distraction osteogenesis. Material and Methods : 14 cleft lip and palate patients ,aged 12 to 18 years of age with severe maxillary and mid-face hypoplasia due to bilateral cleft lip and palate ,uiulateral cleft lip and palate , were treated in our centre with two different techniques after complete Le Fort I osteotomy : one group underwent face mask protraction (10 patients ), and other group underwent internal distraction device ( Dynaform Leibinger)( 4 patients ). Facial and occlusal phothographs and lateral cephalometric radiograph were obtained preoperatively, 3 months and 6 months after distraction. A cephalometric analysis was performed to compare the sagital craniofacial and soft tissue morphology before and afterr distraction. Results: In our series of patients undergoing internal and external maxillary distraction, maxilla was significantly advanced. Midface advancement between 10 and 15 vam was achieved in all patients without complications. Maxillary distraction improved the profile by increasing nasal projection, normalizing nasolabial angle, and making the upper lip more prominent The facial concavity turned into facial convexity. The profile changed from a prognatic into an orthognathic face.The final occlusal relation was satisfaing and negative overjets in all patients were corected to normal values. Postdistraction cephalometric evaluation revealed normalization of most of cephalometric values. No relapses were observed. All patients were kept under orthodontic control during distraction. Conclusion: Distraction osteogenesis offers new perspectives in the early treatment of midfacial hypoplasia. The major advantage is the ability to direct and control the maxUla during distraction procedure. MaxiUary distraction is an effective option for maxiUary hypoplasia in cleft patients.
Purpose: This raport presents the results of distraction osteogenesis using extraoral device among 32 patients with different grades of vertical mandibular ramus hypoplasia and analises the stability of ramus elongation. Material and Methods: A total of 32 patients at the age 2-15 years displaing hypoplastic mandibles were treated with unilateral or bilateral lengthening of the ascending ramus using uni and bilateral extraoral devices (Molina distractor). 5 patients suffered from bilateral hypoplasia and further 27 patients suffered from unUateral hypoplasia. In order to select the appropriate placement of the distractor device,as well as to determinate the placement of the mandibular osteotomy, 3D-CT and cephalometrric radiographs were analised. After 5-day latency period, distraction was commenced in compliance with the standard protocol, until the desired length of distraction was achieved. 3 months after the distraction, the device was removed which allowed the bone and the tissue to stabilise. The evaluation took account of 3D-CT, lateral and P.A. cephalograms, panoramic radiographs, dental models as well as facial photographs before 3, 6 and 12 months after the distraction osteogenesis. Results: Total distraction distances amounted to 5-37 mm with a mean lengthening distance equalling 16,5 mm. With the use of clinical results and radiografic data it became clearly evident that mandibular distraction occurred among all the patients. Lateral, P.A. cephalometric as well as panoramic radiographs displayed progressive ossification of distraction regenerate. No relapses were oberved. rlanned over correction of dental occlusion was achieved to overcome deficient mandibular growth. A coordinated growth between maxillary and mandibular arches witgh stable occlusion are being observed among our patients. Conclusion: Mandibular distraction osteogenesis has proved to offer new Derspectives as far as treatment of mandibular deficiency is concerned. Careful and intact planning of treatment coupled with control of distraction vector can bring about predictable results with minimal morbidities. Nevertheless, it is our conclusion that good and effective orthodontics within the period of consolidation is the key to achive satisfactory stability results.
