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Maxillary distraction complications in cleft patients.

Y Jeblaoui1, B Morand, M Brix

  • 1Maxillofacial Surgery Unit, Hôpital A. Michallon, BP 217, 38043 Grenoble cedex 09, France.

Revue De Stomatologie Et De Chirurgie Maxillo-Faciale
|June 18, 2010
PubMed
Summary

Maxillary distraction in cleft lip and palate (CLP) patients frequently causes complications, mostly device-related, but these rarely impact the final outcome. Careful device selection and consideration of osteotomy-related issues are crucial for successful treatment.

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Area of Science:

  • Craniofacial surgery
  • Orthodontics
  • Pediatric plastic surgery

Background:

  • Cleft lip and palate (CLP) patients often exhibit Class III malocclusion and maxillary hypoplasia.
  • 25-60% of CLP patients require maxillary advancement, achievable via orthognathic surgery or distraction osteogenesis.

Purpose of the Study:

  • To evaluate the complications associated with maxillary distraction in patients with cleft lip and palate.

Main Methods:

  • Retrospective analysis of 8 CLP patients (2000-2007) undergoing Le Fort I osteotomy and maxillary distraction.
  • Utilized external (n=2) and internal (n=6) distractors with a 7-day latency and 1mm/twice-daily activation.
  • Average consolidation period of 4 months, with advancements ranging from 7-19mm (average 12.6mm).

Main Results:

  • Complications occurred in 7 of 8 patients.
  • Observed issues included intra-operative hemorrhage, tooth avulsion, device dysfunction (3 cases), significant pain during activation (2 cases), and labial ulceration (2 cases).
  • Maxillary sinusitis and external device loosening were also noted.

Conclusions:

  • Maxillary distraction in CLP patients presents a high frequency of complications, predominantly device-related.
  • Most complications did not compromise the final surgical result.
  • Device design requires review for improved tolerance, and careful consideration of device type and potential osteotomy complications is necessary.