Prédictibilité de la distraction du maxillaire supérieur avec distracteur trans-sinusien

Abstract

This work was conducted to evaluate a new maxillary distractor with an activating system introduced into the maxilary sinus. Fourteen patients age 8 to 55 Years with severe maxillary and midfacial hypoplasia were treated in our center. A trans-sinusoidal maxillary distractor (TS-MD, developed by Dr. N. Nadjmi in cooperation with Martin, Tuttlingen, Germany) was placed intra-orally at each side of the maxilla. The distraction vector was predicted with devoted software (Medicim N.V Belgium), and was transferred to the patients using stereolithographic models and individual templates. A high Lefort I type osteotomy was performed. Forward maxillary movement at distractor level varied from 7 to 22 mm. Soft and hard tIssue formation resulted in complete healing across the distraction gaps. The maxillary movements and new bone formation in the sagittal, horizontal, and vertical planes could be predicted and achieved. Distractors were designed to allow clockwise rotation of the maxilla during the distraction phase allowing the correction of the anterior open-bite in all patients with this skeletal deformity. The distractors were almost completely submerged, and could be left in place as long as necessary to avoid relapse. The TS-MD distractor has the advantage of good tolerance since the most voluminous part is placed within the maxilary sinus. Implantation via an exclusively oral approach is a further advantage. The devise does not interfere with the patient's social life and does not require alveolodental fixation. The TS-MD distractor can also aleviate the need for bone grafting in cases with major advancement. Correct position of the vector is crucial but one-sided catch-up distraction is possible.