Bone-borne palatal distraction to correct the constricted cleft maxilla.

Area of Science:

• Craniofacial surgery
• Orthodontics
• Pediatric dentistry

Background:

• Transverse maxillary hypoplasia, often with cleft deformity, typically requires orthodontic expansion.
• Management of severe, late-presenting cases or those with failed prior orthodontic care is challenging.
• Tooth-borne expanders have limitations in patients with scarred palates.

Purpose of the Study:

• To assess the efficacy and safety of bone-borne palatal distraction devices.
• To evaluate this device as an alternative treatment for difficult cases of transverse maxillary hypoplasia.
• To compare outcomes in cleft and non-cleft patients.

Main Methods:

• Included 15 older children with constricted maxillas and prior cleft lip/palate repairs who failed orthodontic expansion.
• Performed Le Fort I corticotomy with bone-borne distraction device placement, 0.5 mm/d expansion, and alveolar bone grafting.
• Compared pre- and post-treatment maxillary impressions for intermolar distance, intercanine distance, alveolar cleft width, and palatal area.

Main Results:

• Mean distraction of 14.1 mm achieved over a 19-month follow-up.
• Average increases: intermolar distance 8.4 mm, intercanine distance 9.5 mm, palatal area 28.9 mm2.
• Relapse ranged from 4-7%; all patients received alveolar bone grafting. Non-cleft patients also showed successful distraction with low relapse (4-5%).

Conclusions:

• Bone-borne distraction provides adequate palatal expansion for cleft patients with transverse maxillary hypoplasia who failed prior orthodontic treatment.
• This technique yields stable results, facilitating subsequent alveolar bone grafting.
• It offers a viable alternative for complex cases previously considered difficult to manage.