Internal Maxillary Distraction With a New Bimalar Device
Presented at American Cleft Palate-Craniofacial Association; 62nd Annual Meeting, Myrtle Beach, SC; April 4-9, 2005.
Purpose
Distraction osteogenesis of the Le Fort I segment is advocated for patients who require significant advancement of the maxilla or who have a soft tissue envelope compromised by scar tissue. We present a technique for maxillary distraction using an interconnecting intraoral device anchored to the malar prominences above the osteotomy and either the maxilla and/or the dentition below the level of the osteotomy.
Materials and Methods
Ten patients with nonsyndromic cleft lip and palate, mean age of 18, underwent Le Fort I maxillary distraction osteogenesis for management of maxillary hypoplasia. A Le Fort I osteotomy is performed and a Spectrum Intraoral Midface Multi-Vector Distractor (OsteoMed, Addison, TX) is placed leaving a 1 mm to 2 mm distraction gap. After a 2 to 4 day latency period, distraction begins at a rate of 1 mm a day. Once the desired occlusion is achieved the device is left in place for a minimum of 2 months for consolidation.
Results
Preoperative Sella-Nasion-A point measurements from lateral cephalograms averaged 74 degrees (range, 70-76 degrees). Postoperative Sella-Nasion-A point averaged 81 degrees (range, 75-89 degrees). Preoperative overjet averaged −7.4 mm (range, −3 to −13 mm). Postoperative overjet averaged 2.6 mm (range, 1-3 mm). Average distraction was 9 mm (range, 6-16 mm). The average vertical movement was 7.2 mm in an inferior direction (range, 0-15 mm). The results remained stable at a follow-up of 30 months.
Conclusions
We report on distraction of the Le Fort I segment using an internal device. The device design allows the forces of distraction to be shared across a larger surface area delivering a uniform and reliable vector of distraction with increased stability.
⁎Assistant Professor, Division of Plastic Surgery, Stanford University Medical Center, Stanford, CA.
‡Professor Emeritus of Surgery, Division of Plastic Surgery, Stanford University Medical Center, Stanford, CA.
Address correspondence and reprint requests to Dr Kahn: Division of Plastic Surgery, Stanford University Medical Center, 770 Welch Road, Suite 400, Palo Alto, CA 94304
No funding was used in the completion of this study.
Joseph Broujerdi, MD, DMD, and David M. Kahn, MD have no financial interest in the device used in this study. Stephen A. Schendel, MD, DDS, is a consultant for Osteomed and designed the device used in this study.
ABSTRACT