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Trans-sinusoidal maxillary distraction in three cleft patients.

M Wenghoefer1, M Martini, N Nadjmi

  • 1Department of Oral & Maxillofacial Surgery, University of Bonn, Sigmund-Freud-Str. 25, Bonn 53105, Germany.

International Journal of Oral and Maxillofacial Surgery
|October 4, 2006
PubMed
Summary

The trans-sinusoidal maxillary distractor (TS-MD) effectively advanced the maxilla in cleft lip and palate patients. This method provided predictable results with no relapse, also offering rigid internal fixation post-distraction.

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Area of Science:

  • Craniofacial Surgery
  • Orthodontics
  • Biomedical Engineering

Background:

  • Maxillary hypoplasia is common in patients with repaired cleft lip and palate.
  • Conventional surgical techniques for maxillary advancement have limitations.

Purpose of the Study:

  • To evaluate the efficacy and outcomes of using the trans-sinusoidal maxillary distractor (TS-MD) for maxillary advancement in patients with repaired cleft lip and palate.

Main Methods:

  • Preoperative computer-aided planning and stereolithographic modeling were used to customize TS-MD devices.
  • Intraoperative device positioning utilized a methyl-methacrylate template.
  • TS-MD devices were intraorally activated after Le Fort I osteotomy and remained in situ for rigid internal fixation.

Main Results:

  • Successful maxillary distraction was achieved in all three patients, with advancements of 12 mm, 8 mm, and 11 mm.
  • Additional maxillary widening (6 mm and 8 mm) was accomplished in two patients by using divergent distraction vectors.
  • No relapse occurred during the 3-month consolidation period and 12-month follow-up; however, clockwise rotation of the maxilla was observed in two patients.

Conclusions:

  • The TS-MD is a viable tool for maxillary advancement and rigid internal fixation in cleft lip and palate patients.
  • Preoperative 3D planning enhances predictability, but potential clockwise rotation requires consideration during surgical planning.
  • The device offers functional and social benefits, leaving no extraoral scars.