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Internal maxillary distraction with a new bimalar device.

David M Kahn1, Joseph Broujerdi, Stephen A Schendel

  • 1Division of Plastic Surgery, Stanford University Medical Center, Stanford, CA, USA. David.Kahn@stanford.edu

Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons
|March 22, 2008
PubMed
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This study shows that internal devices for Le Fort I distraction osteogenesis provide stable maxillary advancement in patients with cleft lip and palate. The technique effectively corrects maxillary hypoplasia and improves overjet, offering a reliable solution for complex cases.

Area of Science:

  • Craniofacial surgery
  • Orthognathic surgery
  • Distraction osteogenesis

Background:

  • Le Fort I distraction osteogenesis is indicated for significant maxillary advancement or compromised soft tissue.
  • An innovative intraoral device anchored to malar prominences and maxilla/dentition is presented.

Purpose of the Study:

  • To present a technique for maxillary distraction using an internal, multi-vector device.
  • To evaluate the efficacy and stability of this technique in patients with maxillary hypoplasia.

Main Methods:

  • Ten patients with nonsyndromic cleft lip and palate underwent Le Fort I osteotomy and maxillary distraction.
  • A Spectrum Intraoral Midface Multi-Vector Distractor was used, with distraction initiated after a 2-4 day latency period at 1 mm/day.
  • The device remained for a minimum of 2 months for consolidation.

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Main Results:

  • Mean Sella-Nasion-A point increased from 74 to 81 degrees, correcting skeletal discrepancies.
  • Mean overjet improved from -7.4 mm to 2.6 mm, achieving a positive overjet.
  • Average maxillary advancement was 9 mm, with an average inferior repositioning of 7.2 mm. Stability was maintained at 30 months.

Conclusions:

  • Internal device-based Le Fort I segment distraction offers a uniform and reliable vector of distraction.
  • The device design distributes distraction forces over a larger area, enhancing stability.
  • This technique provides a stable and effective method for managing maxillary hypoplasia.