Midface Distraction in Maxillary Hypoplasia Secondary to Cleft Lip and Plate.

BACKGROUND : cleft patients with moderate or severe maxillary hypoplasia has always been a challenge to treat by the orthognathic surgeon . These cases often require large movements but is always limited by the scar tissue. Conventional orthognathic surgery has been a choice of treatment but due to the high rate of relapse , distraction osteogenesis is preferred by many surgeons recently. The use of distraction osteogenesis over the facial region offers many advantages with lesser rate of relapse and the soft tissue adaptation to the soft tissue changes. Thus the use of distraction device is an alternative to orthognathic surgery for the correction of complex maxillofacial deformities AIM: To study the outcome of mid face distraction using an intraoral device in maxillary hypoplasia secondary to cleft lip & palate to create a stable functional occlusion & good facial esthetic form MATERIAL AND METHODS: This clinical studies was done on 4 patient with a custom made internal distraction device after a lefort 1 osteotomy cut. Pre-operative radiographs were done for many patient. After the surgery the patient were put on latency period for 5 to 7 days. The distraction was done at a rate of 1 mm per day. After the distraction the patient were kept on a consolidation period of 4 times the distraction period. The stage 2 surgery was done for distraction device removal after which patient have to wait for 6 months for lip revision and rhinoplasty. RESULTS: All the 4 patient had maxillary hypoplasia secondary to cleft lip and palate. There was active movement of maxilla for all the patient. The midfacial movement was evaluated by using the following parameters clinical assessment, radiological assessments, Complication, Patient compliance, Overall patient satisfaction. The amount of maxilla advanced was around 20 mm. INTERPRETATION AND CONCLUSION : In this study The amount of maxillary advancement achieved ranged between 15mm to 20mm for the patient which was clinically and radiologically satisfactory. There were few disadvantages that was encountered during the distraction period like pain during distraction which was bearable, stiffness of the device, impingement of the device over the buccal mucosa but overall the results that was achieved was quite satisfactory. The use of intraoral maxillary distraction device for correction of maxillary hypoplasia secondary to cleft lip and palate is a new paradigm shift in the treatment of maxillary defect over orthognathic surgery.