Enhanced Sutural Protraction: An Innovative Orthopedic Protocol for Midfacial Advancement in Growing Patients

Area of Science:

• Craniofacial Surgery
• Orthodontics
• Pediatric Dentistry

Background:

• Midfacial hypoplasia presents significant clinical challenges in growing patients.
• Existing surgical and orthodontic treatments for midface advancement have limitations, including high relapse rates and variable outcomes.

Purpose of the Study:

• To evaluate the effectiveness and stability of the Meazzini-Mazzoleni Enhanced Sutural Protraction (MMESP) protocol for correcting severe midfacial hypoplasia in pediatric patients.

Main Methods:

• Ten growing patients with severe midfacial hypoplasia underwent the MMESP protocol, involving circum-maxillary suture maturation assessment, suture release (palatal expansion or modified Alt-RAMEC), and rigid external distraction without osteotomies.
• Skeletal changes were quantified using lateral cephalograms and craniofacial CT scans, with follow-up at 12 months post-treatment.

Main Results:

• The MMESP protocol achieved significant and stable midface advancement, averaging 15.68 mm at A point, resulting in full correction.
• 3D CT analysis confirmed movement consistent with a Le Fort III osteotomy trajectory, with maximal effect at the maxillary alveolar bone.
• Bone apposition was observed along circum-maxillary sutures, indicating successful skeletal remodeling.

Conclusions:

• The MMESP protocol offers a safe, effective, and stable method for correcting severe midfacial hypoplasia in growing individuals.
• This protocol demonstrates excellent outcomes and provides a valuable alternative to traditional surgical and orthodontic interventions.