Abstract
Objectives: We report our experience and the protocol we used in managing maxillary hypoplasia in cleft lip and palate patients. Patients and methods: 14 adult cleft lip and palate patients with maxillary hypoplasia were evaluated clinically. Dental models and radiographs including (lateral cephalograms and orthopantographs) were obtained at the initial visit and upon completion of the presurgical orthodontic treatment. Patients with occlusal discrepancies larger than 6 mm and severe palatal scaring underwent Distraction osteogenesis (DO) to advance the maxilla. Patients with an occlusal discrepancy of 6 mm or less, underwent traditional orthognathic surgery including le fort I advancement and Bilateral sagittal split osteotomy (BSSO) to seat the mandible in occlusion. Results: Five patients underwent orthognathic surgery. Two of them underwent double jaw surgery. Three underwent single jaw conventional le fort l advancement. Four patients required bone grafting to repair the residual alveolar defect and to augment the midface deficiency. Nine patients with severe maxillary hypoplasia underwent maxillary advancement using distraction osteogenesis. Conclusion: Patients with a severe maxillary hypoplasia of 6 mm or more and excessive palatal scaring are successfully treated with DO. Conventional le fort I is reserved for patients with less severe maxillary hypoplasia. Both techniques gave promising results providing having followed the proper selection criteria.
Highlights
Cleft lip and palate patients are borne with a challenging deformity that requires multiple surgical interventions in order to reach functional and esthetic harmony
We report our experience and the protocol we used in managing maxillary hypoplasia in cleft lip and palate patients
Ross et al [7] showed that about 25% of patients with unilateral cleft lip and palate develop maxillary hypoplasia that does not respond to orthodontic treatment alone
Summary
Cleft lip and palate patients are borne with a challenging deformity that requires multiple surgical interventions in order to reach functional and esthetic harmony. On the bright side of the spectrum Distraction osteogenesis (DO) played a huge role in managing midface hypoplasia (DO) was first introduced to the mandible by McCarthy et al [2], to the maxilla of cleft lip and palate patients by Polley and Figueroa [3]. This gave very good results in treating the hypoplastic maxilla. Many surgeons applied this valuable technique on cleft lip and palate patients and reported the effectiveness of midface DO [4]
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