Treatment of Maxillary Cleft Palate: Distraction Osteogenesis Versus Orthognathic Surgery—Part One: Maxillary Distraction

Abstract

Primary cleft lip and palate repair done during infancy and early childhood improves facial appearance, speech, and deglutition, but a long-term negative effect of these early surgical interventions is impairment of maxillary growth, which produces secondary deformities of the jaw and malocclusion. 1 Bardach J. Salyer E.K. Surgical techniques in cleft lip and palate. Mosby, St Louis, MO1991 Google Scholar , 2 Ross R.B. Treatment variables affecting facial growth in complete unilateral cleft lip and palate: An overview of treatment and facial growth. Cleft Palate Craniofac J. 1987; 24: 71 Google Scholar Ross 2 Ross R.B. Treatment variables affecting facial growth in complete unilateral cleft lip and palate: An overview of treatment and facial growth. Cleft Palate Craniofac J. 1987; 24: 71 Google Scholar showed that about 25% of patients with unilateral cleft lip and palate develop maxillary hypoplasia that does not respond to orthodontic treatment alone. The hypoplastic maxilla is usually advanced later by Le Fort I osteotomy, with or without bone grafting, to reestablish facial balance and occlusion. 3 Maegawa J. Sells R.K. David D.J. Speech changes after maxillary advancement in 40 cleft lip and palate patients. J Craniofac Surg. 1998; 9: 177 Crossref PubMed Scopus (42) Google Scholar , 4 Stoelinga P.J. vd Vijver H.R. Leenen R.J. et al. The prevention of relapse after maxillary osteotomies in cleft palate patients. J Craniomaxillofac Surg. 1987; 15: 326 Abstract Full Text PDF PubMed Scopus (39) Google Scholar , 5 Stoelinga P.J. Haers P.E. Leenen R.J. et al. Late management of secondarily grafted clefts. Int J Oral Maxillofac Surg. 1990; 19: 97 Abstract Full Text PDF PubMed Scopus (46) Google Scholar , 6 Thongdee P. Samman N. Stability of maxillary surgical movement in unilateral cleft lip and palate with preceding alveolar bone grafting. Cleft Palate Craniofac J. 2005; 42: 664 Crossref PubMed Scopus (42) Google Scholar However, the maxilla in these patients is often difficult to mobilize because of scarring from previous operations. In spite of improvements in surgical fixation, cleft patients have a greater tendency to relapse than do noncleft patients with maxillary hypoplasia that may adversely affect final surgical results. 3 Maegawa J. Sells R.K. David D.J. Speech changes after maxillary advancement in 40 cleft lip and palate patients. J Craniofac Surg. 1998; 9: 177 Crossref PubMed Scopus (42) Google Scholar , 4 Stoelinga P.J. vd Vijver H.R. Leenen R.J. et al. The prevention of relapse after maxillary osteotomies in cleft palate patients. J Craniomaxillofac Surg. 1987; 15: 326 Abstract Full Text PDF PubMed Scopus (39) Google Scholar , 5 Stoelinga P.J. Haers P.E. Leenen R.J. et al. Late management of secondarily grafted clefts. Int J Oral Maxillofac Surg. 1990; 19: 97 Abstract Full Text PDF PubMed Scopus (46) Google Scholar , 6 Thongdee P. Samman N. Stability of maxillary surgical movement in unilateral cleft lip and palate with preceding alveolar bone grafting. Cleft Palate Craniofac J. 2005; 42: 664 Crossref PubMed Scopus (42) Google Scholar