Upper Airway Changes after Maxillary Distraction Osteogenesis in Cleft Lip and Palate Patients

S. Abuzinada,A. Alyamani

doi:10.4236/ojst.2016.61003

Abstract

Purpose: To measure the upper airway changes associated with maxillary distraction osteogenesis in cleft lip and palate patients in the immediate post operative period and 12 months later. Materials and Methods: Seven patients with repaired cleft lip and palate (CLP) presented with severe maxillary hypoplasia. They were examined initially at T1 predistraction phase. Records taken included radiographs (orthopantograms OPG, lateral cephalometric, posteroanterior). Cephalometric analysis was done to evaluate the upper airway. Mean age is 17 years and the reverse overjet > 6 mm. They underwent maxillary Le Fort I distraction using external rigid distracters (RED). Cephalometric analysis to evaluate the upper airway was repeated at the end of the consolidation phase T2 and twelve months after distractor removal T3. Results: The range of maxillary advancement was between 8 - 15 mm (mean 9 mm). The anteroposterior distance of the superior velopharynx (PPS) and middle velopharynx (SPPS) increased at T2. A small amount of reduction in these values was recorded at T3. The inferior velopharynx (MPS) and the oropharynx (IPS, EPS) showed minimum increase in anteroposterior distance in only two patients at T2 and no change at T3. Conclusion: All seven patients showed clinical improvement in the upper airway and an increase in the upper airway values on lateral cephalometric radiographs.

Highlights

Cleft lip and palate patients usually present with a challenging midface hypoplasia that creates both esthetic and functional problems in addition to a compromised upper airway
This is a great advantage in cleft lip and palate patients who present with severe palatal scaring and require large maxillary advancements. For this reason surgeons applied distraction osteogenesis methods on cleft lip and palate patients and reported the effectiveness of distraction on function and esthetics [2]. Another major advantage of Distraction Osteogenesis (DO) is that it makes large maxillary advancements possible which produces a noticeable increase in the upper airway structures and a reduction in airway resistance
It has been noted that when maxillary distraction osteogenesis was used to advance the maxilla in cleft lip and palate patients, the greater the amount of maxillary advancement the greater the changes and enlargement in the upper airway structure with a reduction in airway resistance

Summary

Introduction

Cleft lip and palate patients usually present with a challenging midface hypoplasia that creates both esthetic and functional problems in addition to a compromised upper airway. The advantages of DO are numerous, including the ability of the soft tissues to gradually remodel and adapt to the underlying bony advancement This is a great advantage in cleft lip and palate patients who present with severe palatal scaring and require large maxillary advancements. For this reason surgeons applied distraction osteogenesis methods on cleft lip and palate patients and reported the effectiveness of distraction on function and esthetics [2] Another major advantage of DO is that it makes large maxillary advancements possible which produces a noticeable increase in the upper airway structures and a reduction in airway resistance. With maxillary distraction a larger advancement is achieved, more changes are noted in maxillary skeletal position, soft palate position and pharyngeal airway size These dramatic changes show better stability than conventional Le Fort I advancement [3] [5] [6]. The aim of this retrospective study was to measure the upper airway changes that occurred with maxillary distraction osteogenesis in cleft lip and palate patients in the immediate post operative period and 12 months later

Patients and Methods

Cephalometric Evaluation

Results

Discussion