Abstract
Trans-sutural distraction osteogenesis (TSDO) promotes midface growth in growing cleft lip and palate (CLP) patients with midfacial hypoplasia. The superficial skeletal changes after therapy revealed rotation advancement of the midfacial skeleton associated with differential displacement in each segment, but reports rarely focus on the changes of internal structures, including circummaxillary sutures, the maxillary tuberosity and the maxillary sinus, which may play a crucial role during this process. This study evaluated the computed tomographic (CT) images of 26 growing CLP patients who received bone-borne TSDO therapy. The results revealed that the most prominent new bone formation occurred in the pterygomaxillary suture and pushed the P-point forward. The maxillary first molar exhibited significantly greater advancement compared with the P-point due to the growth of the maxillary tuberosity. The contribution ratio values of the advancement of the maxillary tuberosity and P-point to the maxillary first molar were 26% and 74%, respectively, in UCLP and 25% and 75%, respectively, in BCLP. Furthermore, the maxillary sinus volume was also significantly increased. In conclusion, midface growth with bone-borne TSDO therapy depends on both secondary displacement promoted by sutural bone formation mainly in the pterygomaxillary suture and primary displacement by growth of the maxillary tuberosity and maxillary sinus volume.
Highlights
The normal growth and development of midfacial skeleton, which is defined as the nasomaxillary and zygomatic bones, depends on two fundamental mechanisms: secondary displacement promoted by the cranial base structure growth and primary displacement by the growth modelling of the skeleton itself
Patients affected by cleft lip and palate (CLP) are most susceptible to develop into midfacial hypoplasia and typically present an asymmetrical or symmetrical concave facial profile associated with skeletal Class III malocclusion and narrow dental arch early in life[3,4]
Midfacial hypoplasia in CLP patients results from a combination of intrinsic growth deficiency and iatrogenic factors
Summary
The normal growth and development of midfacial skeleton, which is defined as the nasomaxillary and zygomatic bones, depends on two fundamental mechanisms: secondary displacement promoted by the cranial base structure growth and primary displacement by the growth modelling of the skeleton itself. Patients affected by cleft lip and palate (CLP) are most susceptible to develop into midfacial hypoplasia and typically present an asymmetrical or symmetrical concave facial profile associated with skeletal Class III malocclusion and narrow dental arch early in life[3,4]. This phenomenon is attributed to 2 aspects: intrinsic growth deficiency and iatrogenic factors caused by operation-based sequential therapy[5,6,7]. The purpose of this study was to analyse the computed tomogram (CT) images of 26 growing CLP patients with midfacial hypoplasia undergoing bone-borne TSDO therapy and further elaborate the role of circummaxillary sutures, the maxillary tuberosity and the maxillary sinus in this process
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