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Maxillary Distraction Osteogenesis as both Bridge to and Replacement for Orthognathic Surgery in Patients with Cleft
Benjamin B Massenburg1,2, Dominic J Romeo1, Steven Du1
1From the Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia.
Background:
Although maxillary distraction osteogenesis (MaxDO) has demonstrated superior bone healing in patients with cleft lip and palate (CLP), its clinical use is relatively unreported. Questions persist regarding its effectiveness in treating severe maxillary retrusion, its ability to achieve adequate dentofacial correction, and whether it is better deployed as a bridge to definitive orthognathic surgery.
Methods:
The authors retrospectively reviewed all patients with a diagnosis of CLP who underwent MaxDO from 2007 through 2022 and determined predictors for long-term occlusal normalization and risk factors for relapse and additional orthognathic surgery. Chi-square tests were used for binomial variables and a multivariable logistic regression was performed.
Results:
Twenty-six patients with CLP who underwent MaxDO for midface hypoplasia and Angle class III malocclusion between ages 9.0 and 19.2 years were included. In female patients, MaxDO achieved stable occlusion without additional surgical intervention in 83.3% of those who underwent surgery after age 13.5 years, compared with 20.0% of those who underwent surgery before age 13.5 years (P = 0.036). In male patients, MaxDO achieved stable occlusion in 50.0% of those who underwent surgery after age 17 years, compared with 0% of those who underwent surgery before age 17 years (P = 0.018). On multivariable logistic analysis, older age at time of MaxDO was associated with long-term normalization of occlusion without additional procedures (P = 0.045).
Conclusions:
MaxDO effectively achieves stable maxillary advancements of greater than 12 mm in patients with CLP. In young children, MaxDO may normalize severe midface hypoplasia through secondary school ages as a bridge to definitive orthognathic surgery. In skeletally mature patients, MaxDO may achieve stable normalization of occlusion without need for further orthognathic surgery.
