Maxillary protraction in adult cleft lip and palate by a rigid external distraction device with dentoskeletal anchorage

Objective: The objective is to evaluate the effects of maxillary distraction osteogenesis (DO) in an adult patient with unilateral cleft lip and palate (UCLP) by using a rigid external distraction (RED) device with dentoskeletal anchorage. Method: 31-year-old male patient with UCLP with severe maxillary hypoplasia, dolichofacial growth pattern, negative overjet and 1.5 mm openbite. After pre-surgical orthodontic treatment, an intra-oral appliance was modified to prevent extrusion of the molars and clockwise rotation of the mandible. Stainless steel plates were soldered bilaterally to the intra oral appliance at the level of canines. During surgery, miniplates were inserted in the maxillary segment and fixed to the plates of the intra oral appliance with screws. Results: The mean distraction length was 12 mm immediately after DO. SNA increased from 73o to 82o after distraction. A significant advancement of the maxilla and correction of the sagittal Class III skeletal relationship was achieved. The vertical position of the mandible and the face was kept stable, and the soft tissue profile became more balanced. Conclusion: This intra oral appliance design achieved desired skeletal changes during maxillary protraction with RED device in dolichofacial CLP patient. Occlusion and facial profile changes was found to be stable in 1-year follow-up.PubMe

Treatment of Cleft lip & Palate Related Maxillary Hypoplasia with RED System: Case Report

Clefts of the lip and palate present one of the most challenging congenital disorders to the orthodontists and craniofacial surgeons. A common finding is maxillary hypoplasia. Current case report presents the treatment of a 19 years old female unilateral cleft lip and palate patient characterized with maxillary constriction, retrusion and severe underjet. The case has been successfully treated with fixed appliance therapy and rigid external distraction and relapse at the end of treatment is minimal. However, longer follow-ups are required to assess the exact amount of stability

Reconstruction of mandibular defects using autografts combined with demineralized bone matrix and cancellous allograft

WOS: 000243853800018PubMed: 17251844Facial bone defects can be managed by a variety of means, such as inlay or onlay applied nonvascularized bone grafts, local pedicled/distal free osteocutaneous/osseous flaps or distraction osteogenesis. Although each method has its own advantages and drawbacks, the indications of using these methods may overlap in certain clinical situations. The use of nonvascularized bone grafts, conceptually and technically simple method, relies on creeping substitution of applied graft with regenerating new bone. However, using vascularized osteocutaneous free flaps provide not only plenty of bony tissue for reconstruction, but also soft tissue coverage over the reconstructed bony segment. Furthermore, bone healing in vascularized osteocutaneous free flaps resembles as the physiologic fracture healing. In selected cases with enough soft tissue coverage over the defective bony segment, on the other hand, using larger nonvascularized bone grafts with osteoinductive growth factors may decrease the risk of graft failure while avoiding the drawbacks of the free tissue transfer. Here we present our results of three cases with facial bone defects, to which nonvascularized iliac bone grafts and demineralized bone matrix with cancellous allograft (Orthoblast II (TM)) as a source of BMP were used together for mandibular reconstruction