One-step transversal palatal distraction and maxillary repositioning: technical considerations, advantages, and long-term stability.

One-step transversal palatal distraction and maxillary repositioning: technical considerations, advantages, and long-term stability. Cortese A, Savastano M, Savastano G, Claudio PP. Source Department of Oral and Maxillofacial Sciences, University of Naples Federico II, Naples, Italy. Abstract BACKGROUND: Transversal maxillary hypoplasia in adolescence is a frequently seen pathology, which can be treated with a combination of surgery and orthodontic treatment to widen the maxilla in skeletally matured patients.We evaluated the advantages of a new surgical technique: Le Fort I distraction osteogenesis using a bone-borne device. Because relapse is one of the main problems in surgical maxillary expansion, long-term stability of this new technique was evaluated. METHODS: Data from 4 adult patients with maxillary restriction, class III malocclusion, or maxillary malposition were collected preoperatively, 4 months after distraction, and 5 years after distraction. Measurements were recorded on dental models to detect palatal expansion at dental level; cephalograms by lateral and posteroanterior plane were analyzed to detect maxillary movements. RESULTS: Maxillary measurements were substantially stable 5 years after distractions. Only minor dental movements occurred at the dental analysis after 5 years related to a lack of orthodontic contention without any compromise of the dental result (no crossbite relapse and class I stability). CONCLUSIONS: Le Fort I with down-fracture for expansion and repositioning by bone-borne distractor device cannot be used to simultaneously widen, advance, and vertically reposition the maxilla without causing healing problems, particularly using a rigid distraction device. Long-term stability can be achieved; however, further studies with a larger number of patients will be necessary for better evaluation. PMID: 21959418 [PubMed - indexed for MEDLINE

Le Fort I Osteotomy for Maxillary Advancement and Transversal Palatal Distraction in 1 Stage: Five Years Follow up

Osteotomia di Le Fort I per avanzamento mascellare e distrazione palatale in unico tempo: follow up a 5 anni

New technique: Le Fort I osteotomy for maxillary advancement and palatal distraction in 1 stage.

nuova tecnica di avanzamenti e distrazione del mascellare in unico tempo chirurgic

New technique: Le Fort I osteotomy for maxillary advancement and palatal distraction in 1 stage.

Transversal palatal distraction is a new method for treating transversal maxillary hypoplasia using the osteodistraction procedure, which has proven very valuable in other surgical fields.1 For many years, maxillary width discrepancies have been corrected in pediatric patients solely by orthodontic therapies, such as slow orthodontic expansion (SOE) and rapid palatal expansion (RPE), and in adult patients by surgical treatments such as surgically assisted rapid palatal expansion (SARPE) and 2-segment Le Fort I-type osteotomy with expansion (LFI-E).2 Although commonly performed, these therapies present some problems related to the tooth-borne appliances (ie, SOE, RPE, SARPE),3 including alveolar bone bending, periodontal membrane compression, root reabsorption, and lateral tooth displacement and extrusion.4 Longterm stability remains problematic as well.5 Relapse is the main problem after a LFI-E maxillary osteotomy combined with a midpalatal osteotomy,6 probably due to the lack of a palatal retention appliance, fibrous scar retraction, and palatal fibromucosal traction