SEARCH WITHIN CONTENT
Citation Information : Australasian Orthodontic Journal. Volume 36, Issue 2, Pages 205-210, DOI: https://doi.org/10.21307/aoj-2020-023
License : (CC BY 4.0)
Published Online: 20-July-2021
Background: The correction of severe maxillary retrognathia in patients presenting with a cleft palate is challenging due to the complexity of the orthodontic preparation and the magnitude of the surgical movements required, along with the relatively high risk of relapse.
Materials and methods: An 18-year-old Caucasian male with a repaired left-side unilateral cleft lip and palate presented with concerns relating to poor facial aesthetics and poor occlusion. Multidisciplinary treatment involving orthodontics and orthognathic surgery were undertaken to correct the severe maxillary retrognathia. The correction involved the use of internal distraction osteogenesis followed by a conventional maxillary Le Fort I advancement with rotation.
Results: Pre- and post-treatment lateral cephalogram measurements showed the maxilla was advanced 18 mm, rotated clockwise producing a 9 mm increase in vertical dimension at A point and a 7 mm gain in relative arch width across the first molars. Follow-up CBCT superimpositions showed excellent skeletal stability of the achieved anterior-posterior, lateral and vertical corrections over a 2.4-year period, although there was some minor dental relapse.
Conclusion: This case report illustrates the successful use of orthodontics and distraction osteogenesis followed by conventional Le Fort I advancement surgery to correct a severely retrognathic maxilla in a patient with a repaired unilateral cleft lip and palate.
1. Ross RB. Treatment variables affecting facial growth in complete unilateral cleft lip and palate. Part 7: An overview of treatment and facial growth. Cleft Palate J 1987;24:71-7.
2. Rachmiel A. Management of maxillary cleft deficiency using external and internal distraction devices — long-term results. Int J Oral Maxillofac Surg 2017;46:43.
3. Long RE, Semb G, Shaw WC. Orthodontic Treatment of the Patient With Complete Clefts of Lip, Alveolus, and Palate: Lessons of the Past 60 Years. Cleft Palate-Craniofacial J 2000;37:1-13.
4. Kloukos D, Fudalej P, Sequeira-Byron P, Katsaros C. Maxillary distraction osteogenesis versus orthognathic surgery for cleft lip and palate patients. Cochrane Database Syst Rev 2018; Access verified Oct 9, 2019. doi: 10.1002/14651858.CD010403.pub3.
5. Scolozzi P. Distraction osteogenesis in the management of severe maxillary hypoplasia in cleft lip and palate patients. J Craniofac Surg 2008;19:1199-214.
6. Rachmiel A, Even-Almos M, Aizenbud D. Treatment of maxillary cleft palate: Distraction osteogenesis vs. orthognathic surgery. Ann Maxillofac Surg 2012;2:127-30.
7. Wang X-X, Wang X, Li Z-L, Yi B, Liang C, Jia Y, Zou B-S. Anterior maxillary segmental distraction for correction of maxillary hypoplasia and dental crowding in cleft palate patients: a preliminary report. Int J Oral Maxillofac Surg 2009;38:1237-43.
8. Drew SJ. 21 years of distraction and counting, the New York Center for Orthognathic and Maxillofacial Surgery experience on Long Island…. Int J Oral Maxillofac Surg 2017;46:15.
9. Nevzatoğlu S, Küçükkeleş N, Güzel Z. Long term stability of intraoral maxillary distraction in unilateral cleft lip and palate: a case report. Aust Orthod J 2013;29:200-8.
10. Cheung LK, Chua HD. Distraction or orthognathic surgery for cleft lip and palate patients: which is better? Ann R Australas Coll Dent Surg 2008;19:133-5.