Distraction Osteogenesis for severe cleft maxillary hypoplasia: Results in growing and non-growing patients

Objectives: Rigid external distraction osteogenesis has been demonstrated a safe and highly effective procedure for the treatment of severely retruded cleft lip and palate patients. The purpose of this study was to evaluate immediate result, long term skeletal stability and effect on velopharingeal function after maxillary distraction osteogenesis. Material and Method: The study included 8 growing patients (average age 8 years) and 10 non growing patients (average age 24 years) with unilateral or bilateral cleft lip and palate and a severe midface retrusion treated with distraction osteogenesis. An external device with dental anchorage was utilized. Lateral cephalometric x rays were performed pre-op, at the end of distraction osteogenesis and at different follow up times. The average follow up was 4 years (range 1-8 years). Parameters evaluated in the immediate post-op x rays were vertical and horizontal maxillary movement, mandibular and occlusal plane angle changes and soft palate movement. In the subsequent follow up x rays vertical and horizontal relapse, mandibular and occlusal plane angle changes and soft palate adaptation were analyzed. A speech pathologist evaluated the sample pre, immediately post op and 1 year post op. Results: The immediate result showed a good maxillary advancement, with morphological and aesthetic restoration in both growing and non growing groups. The long term follow up showed a moderate vertical and horizontal relapse in growing patients probably due to disproportionate growth inherent in cleft lip and palate patients, non growing patients showed a stable horizontal maxillary position and a slight vertical relapse. Two patients, borderline pre-op, showed velopharyngeal incompetence and a velopharyngoplasty was performed about 1 year post distraction, speech was temporarily impaired in other patients but no velopharyngeal incompetence was detected any longer at 1 year follow up. Summary: In this study the Authors evaluate their results with rigid external maxillary distraction in growing and non growing cleft patients affected by severe maxillary hypoplasia. Long term stability and velopharyngeal function are considered.