Maxillary distraction osteogenesis in the management of cleft lip and palate: report of 2 cases

Jin-Woo Kim; Sung-Ho Park; Jin-Hyun Jang; Myung-Rae Kim; Sun-Jong Kim

doi:10.5125/jkaoms.2011.37.4.321

Journal List > J Korean Assoc Oral Maxillofac Surg > v.37(4) > 1032484

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Kim, Park, Jang, Kim, and Kim: Maxillary distraction osteogenesis in the management of cleft lip and palate: report of 2 cases

Original Article

J Korean Assoc Oral Maxillofac Surg 2011;37(4):321-328.

Published online: 7 January 2011

DOI: https://doi.org/10.5125/jkaoms.2011.37.4.321

Maxillary distraction osteogenesis in the management of cleft lip and palate: report of 2 cases

Jin-Woo Kim, Sung-Ho Park, Jin-Hyun Jang, Myung-Rae Kim, Sun-Jong Kim

Department of Oral and Maxillofacial Surgery, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea

Sun-Jong Kim Department of Oral & Maxillofacial Surgery, Ewha Womans University Mockdong Hospital, Ewha Womans University School of Medicine 911-1, Mokdong, Yangcheon-gu, Seoul, 158-710, Korea TEL: +82-2-2650-5631 FAX: +82-2-2650-5764 E-mail: sjsj7777@ewha.ac.kr

Received 2 May 201121 July 2011 Accepted 26 July 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

This study is to evaluate the growth and development of the maxilla advanced by transoral distraction osteogenesis of cleft lip and palate children. Subjects are two patients diagnosed as maxillary hypoplasia with cleft lip and palate, and followed up over 5 years after distraction. At the age of 11.4 years (mean), the distraction had been rendered and periodically taken lateral cephalograms were analysed to trace the growth of the maxilla. This cephalometric study showed continuous growth and development of the distracted maxilla to be stable through long term followup.

Keywords: Distraction osteogenesis, Cleft lip and palate, Maxillary growth, Cephalometrics

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Fig. 1.

Clinical photographs at surgery.

Fig. 2.

Treatment protocol for maxillary distraction using an intraoral distractor.

Fig. 3.

Representation of landmarks and constructed lines used to identify craniofacial and dental parameters on lateral cephalometric radiograph. The following points were assessed; N: nasion, S: sella, ANS: anterior nasal spine, PNS: posterior nasal spine, A: subspinale, B: supramentale, Mx1: incisal edge of maxillary central incisor, Pg: pogonion, Gn: gnathion, Go: gonion, Me: menton, Mn1: incisal edge of mandibular central incisor, X-Axis: horizontal reference line-line through nasion rotated 7�upward from sella-nasion line, Y-Axis: vertical reference line-line perpendicular to horizontal reference line through sella.

Fig. 4.

Comparison of clinical photograph. A. Preoperative, B. After distraction osteogenesis, C. Post-op 5 years 8 months.

Fig. 5.

Comparison of Lateral cephalogram. A. Preoperative, B. After distraction osteogenesis, C. Post-op 5 years 8 months.

Fig. 6.

Comparison of Introral photograph, frontal view. A. Preoperative, B. after distraction osteogenesis.

Fig. 7.

Superimposition of Lateral cephlogram.(T0-Black, T1-Red, T5-Green)

Fig. 8.

Comparison of clinical photograph. A. Preoperative, B. After distraction osteogenesis, C. Post-op 5 years 3 months.

Fig. 9.

Comparison of Lateral cephalogram. A. Preoperative, B. After distraction osteogenesis, C. Post-op 5 years 3 months.

Fig. 10.

Superimposition of Lateral cephlogram.(T0-Black, T1-Red, T5-Green)

Table 1.

Patient information

	Patient I	Patient II
Age at the time of distraction	10 yr 8 mo	12 yr 10 mo
Cleft classification	Unilateral complete cleft lip and palate, Lt	Unilateral incomplete cleft lip and palate, R
Previous cheiloplasty	3 mo after birth	4 mo after birth
Previous cleft palate surgery	15 mo after birth	16 mo after birth
Previous reconstruction of alveolar cleft	anterior iliac bone graft reconstruction	anterior iliac bone graft reconstruction
	(9 yr 8 mo)	(12yr 3mo)
Follow-up period	5 yr 8 mo	5 yr 3 mo
Preoperative overjet (mm)	−4.35	−5.84
Amount of advancement done (mm)	8.41	9.08
Postperative overjet / last followup overjet (mm)	4.06/2.20	3.24/-1.75
Actual distracted amount (mm)	10/10 (Rt/Lt)	10/6 (Rt/Lt)
Orthodontic treatment after distraction	Camouflage treatment after	Orthognathic surgery is planned due to
	distraction osteogenesis	remarkable growth of mandible

(yr: year[s], mo: month[s])

Table 2.

Cephalometric analysis of patient I

	T0	T1	T2	T3	T4	T5	T1-T0	T5-T1
SNA (°)	74.11	78.45	78.14	76.54	76.97	76.87	4.34	−1.58
SNB (°)	80.10	77.70	77.57	79.12	79.59	78.42	−2.40	0.72
ANB (°)	−5.99	0.75	0.57	−2.58	−2.62	−1.55	6.74	−2.30
Point A to ver. reference line¹ (mm)	60.19	62.40	62.33	65.54	68.48	70.28	2.21	7.88
Point A to hor. reference line¹ (mm)	61.52	68.24	67.28	68.32	69.48	71.04	6.72	2.80
Point B to ver. reference line¹ (mm)	98.82	97.42	100.03	100.62	114.81	118.42	−1.40	21.00
Point B to hor. reference line¹ (mm)	77.72	77.04	77.82	80.48	80.42	79.02	−0.68	1.98
U1 to SN (°)	99.37	97.08	98.63	94.50	106.24	107.42	−2.29	10.34
Nasolabial angle (°)	83.35	95.62	93.56	95.31	91.13	89.42	12.27	−6.20
Upper lip to E-line (mm)	−7.42	−1.79	−1.70	−2.36	−4.24	−3.28	5.63	−1.49
Lower lip to E-line (mm)	−2.45	−1.60	−1.36	−1.23	−1.84	−1.89	0.85	−0.29
Incisal overjet (mm)	−4.35	4.06	5.68	3.10	2.40	2.20	8.41	−1.86
Incisal overbite (mm)	5.96	2.85	2.12	2.04	2.18	1.98	−3.11	−0.87

(T0: before distraction osteogenesis [DO], T1: after DO, T2: 6 months after DO, T3: 1 year after DO, T4: 2 years after DO, T5: 5 years after DO, ver: vertical, hor: horizontal) ¹: The natural head position (NHP) horizontal and vertical reference lines⁷ were used for measuring amount of Point A and B to reference lines. Refer to Fig. 3.

Table 3.

Cephalometric analysis of patient II

	T0	T1	T2	T3	T4	T5	T1-T0	T5-T1
SNA (°)	73.8	77.24	76.78	76.79	77.08	77.38	3.44	0.14
SNB (°)	75.58	71.79	72.89	74.24	75.27	78.42	−3.79	6.63
ANB (°)	−1.78	5.45	3.89	2.55	1.81	−1.04	7.23	−6.49
Point A to ver. reference line¹ (mm)	79.24	81.22	82.49	84.42	86.28	88.42	1.98	7.20
Point A to hor. reference line¹ (mm)	87.24	94.29	94.38	92.18	94.44	94.01	7.05	−0.28
Point B to ver. reference line¹ (mm)	142.48	146.42	148.89	150.24	149.42	152.37	3.94	5.95
Point B to hor. reference line¹ (mm)	79.42	77.71	79.89	80.42	80.84	84.24	−1.71	6.53
U1 to SN (°)	94.76	103.9	96.12	96.42	94.13	93.42	9.14	−10.48
Nasolabial angle (°)	92.48	88.51	82.1	80.93	89.61	88.42	−3.97	−0.09
Upper lip to E-line (mm)	−3.22	1.73	1.24	1.11	−1.85	−1.94	4.95	−3.67
Lower lip to E-line (mm)	5.42	4.83	4.88	4.72	1.76	2.42	−0.59	−2.41
Incisal overjet (mm)	−5.84	3.24	−0.01	−0.48	−1.24	−1.75	9.08	−4.99
Incisal overbite (mm)	−1.42	0.6	−0.22	−0.83	−0.42	−1.24	2.02	−1.84

(T0: before distraction osteogenesis [DO], T1: after DO, T2: 6 months after DO, T3: 1 year after DO, T4: 2 years after DO, T5: 5 years after DO, ver: vertical, hor: horizontal)

¹ The natural head position (NHP) horizontal and vertical reference lines⁷ were used for measuring amount of Point A and B to reference lines. Refer to Fig. 3.

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