Abstract
We encountered a case of bilateral cleft lip and palate in which, although palatal fistula closure surgery was performed twice using tongue flaps after completing orthodontic treatment, sufficient closure was not achieved. Therefore, to reduce the width of the alveolar cleft and palatal fistula, we performed maxillary alveolar bone movement using interdental distraction osteogenesis and orthodontic treatment, and a good result was obtained.
The patient was a 16-year and 9-month-old boy with bilateral cleft lip and palate, in whom a space was present in the distal area of the maxillary central incisor, and a 16 mm×14 mm palatal fistula remained in the palate. As the treatment plan, we set the mesial area of the bilateral maxillary first molars as the osteotomy line to move the lateral segment together with its alveolar bone in front of the bilateral maxillary first molars in the anterior direction using distraction. We produced a tooth-tooth type distractor in which a Zurich type ramus distractor (Martin Co.) was soldered to orthodontic bands on the right first and left second premolars and first molars. Regarding the distraction method, after a latency period of 1 week, distraction was initiated at the rate of 0.5 mm×2 per day, and the left side was distracted by 5.0 mm, and the right side by 7.5 mm. The consolidation period was 1 month, and the distractor was removed 1 month after distraction. One month after completing distraction, orthodontic treatment using edgewise appliances was started, and the maxillary first molars were anteriorly moved to the bone area which was newly generated by distraction. Thereafter, 1 year after performing distraction, the remaining palatal fistula was closed using auricular cartilage grafting and local flaps. Furthermore, β-TCP, platelet-rich plasma, and medullary fluid filled the alveolar cleft. Thereafter, orthodontic treatment was continued to close the space, and a good occlusal relationship was obtained. The active orthodontic treatment period was 2 years and 11 months.
Application of interdental distraction osteogenesis showed the following advantages:
1. The size of the palatal fistula was reduced and closure of the fistula became easy.
2. The alveolar cleft was closed, and prosthetic treatment became unnecessary.
