A Case of Surgical Orthodontic Treatment with Maxillary Bone Lengthening by Distraction Osteogenesis in Unilateral Cleft Lip and Palate Patient

Abstract

Distraction osteogenesis is a technique of bone lengthening with corticotomy and mechanical distraction device to short and/or deformed bones to regenerate bone and soft tissues. This is a clinical report on a severe skeletal class III patient with unilateral cleft lip and palate treated with maxillary bone lengthening by gradual distraction and sagittal split ramus osteotomy of mandible.
The male patient with unilateral (right) cleft lip and palate was 18 years 5 months old at the beginning of surgical orthodontic treatment. After presurgical orthodontic treatment of the maxilla, forward advancement of the maxilla was done by corticotomy and intraoral appliance with two expansion screws fixed to the maxilla. Maxillary lengthening was performed at 0.7mm and 0.35mm advancement per day for 15 days. It was found that SNA increased 3.5 deg., ANS-PNS increased 2.8mm and the maxilla moved anteriorly. Simulteniously SN-NF decreased 3.5 deg. and the maxilla rotated superiorly. Long-term follow-up (25 months after maxillary bone lengthening) demonstrated that the maxilla slightly relapsed posterio-inferiorly.
It was considered that maxillary bone lengthening by gradual distraction is an effective technique to advance the maxilla of cleft lip and palate patient without exacerbating the rhinopharyngeal closure function.