J Korean Assoc Oral Maxillofac Surg 2017; 43(6): 407~414
Use of repeat anterior maxillary distraction to correct residual midface hypoplasia in cleft patients
Sunil Richardson, Shreya Krishna, Avi Bansal
Richardsons Dental and Craniofacial Hospital, Nagercoil, India
Sunil Richardson
Richardsons Dental and Craniofacial Hospital, #71 Trivandrum Highway, Parvathipuram, Nagercoil 629003, India
TEL: +91-9944428056
E-mail: sunilrichardson145@gmail.com
ORCID: http://orcid.org/0000-0002-2141-9201
Received June 4, 2017; Revised August 8, 2017; Accepted August 22, 2017.; Published online December 31, 2017.
© Korean Association of Oral and Maxillofacial Surgeons. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract
Objectives: The study was designed to evaluate the efficacy of performing a second, repeat anterior maxillary distraction (AMD) to treat residual cleft maxillary hypoplasia.
Materials and Methods: Five patients between the ages of 12 to 15 years with a history of AMD and with residual cleft maxillary hypoplasia were included in the study. Inclusion was irrespective of gender, type of cleft lip and palate, and the amount of advancement needed. Repeat AMD was executed in these patients 4 to 5 years after the primary AMD procedure to correct the cleft maxillary hypoplasia that had developed since the initial procedure. Orthopantomogram (OPG) and lateral cephalograms were taken for evaluation preoperatively, immediately after distraction, after consolidation, and one year postoperatively. The data obtained was tabulated and a Mann Whitney U-test was used for statistical comparisons.
Results: At the time of presentation, a residual maxillary hypoplasia was observed with a well maintained distraction gap on the OPG which ruled out the occurrence of a relapse. Favorable movement of the segments without any resistance was seen in all patients. Mean maxillary advancement of 10.56 mm was achieved at repeat AMD. Statistically significant increases in midfacial length, SNA angle, and nasion perpendicular to point A distance was achieved (P=0.012, P=0.011, and P=0.012, respectively). Good profile was achieved for all patients. Minimal transient complications, for example anterior open bite and bleeding episodes, were managed.
Conclusion: Addressing the problem of cleft maxillary hypoplasia at an early age (12-15 years) is beneficial for the child. Residual hypoplasia may develop in some patients, which may require additional corrective procedures. The results of our study show that AMD can be repeated when residual deformity develops with the previous procedure having no negative impact on the results of the repeat procedure.
Keywords: Cleft palate, Osteogenesis, Distraction, Maxilla


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