• Maxillofacial Plastic and Reconstructive Surgery
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• 제38권
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• pp.20.1-20.6
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• 2016

Background: Most of cleft lip and palate patients have the esthetic and functional problems of midfacial deficiencies due to innate developmental tendency and scar tissues from repeated operations. In these cases, maxillary protraction is required for the harmonious facial esthetics and functional occlusion. Case presentation: A 7-year old boy had been diagnosed as severe maxillary constriction due to unilateral complete cleft lip and palate. The author tried to correct the secondary deformity by early distraction osteogenesis with the aim of avoiding marked psychological impact from peers of elementary school. From 1999 to 2006, repeated treatments, which consisted of Le Fort I osteotomy and face mask distraction, and complementary maxillary protraction using miniplates were performed including orthodontics. But, final facial profile was not satisfactory, which needs compromising surgery. Conclusions: The result of this study suggests that if early distraction treatment is performed before facial skeletal growth is completed, an orthognathic surgery or additional distraction may be needed later. Maxillofacial plastic and reconstructive surgeons should notify this point when they plan early distraction treatment for cleft maxillary deformity.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제27권4호
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• pp.324-333
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• 2005

Distraction osteogenesis for the advancement of hypoplastic maxilla of cleft patients has shown successful results. In this report, rigid external distraction(RED) system and internal distraction device were used for maxillary advancement. Each system has its advantages and disadvantages. Larger amount of advancement can be achieved with RED system. But complex external device may give patients psychological stress. Internal device is invisible. However its distraction amount have limitation for the advancement (< 20mm) and the vector cannot be changed freely during distraction. The authors treated five cleft patients with maxillary hypoplasia(three with RED system and two with internal distractor). Their results were clinically satisfactory. We present the pros and cons of RED and internal system for maxillary distraction osteogenesis.

• 대한구순구개열학회지
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• 제12권1호
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• pp.21-32
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• 2009

Generally, an adult cleft lip or/and palate patient shows some amount of maxillary deficiency due to limitation of bony growth caused by heavy scars resulted from previous operations such as a cheiloplasty and/or a palatoplasty at an early child age. To solve the problem, advancement of the maxilla is usually required during orthognathic surgery. However, severe tensional force resulted from heavy scars on the palate and/or the lip, as well as the bony defect at the cleft area limited sufficient advancement of the maxillary segment and finally caused relapse of the reposed maxilla. Therefore, distraction osteogenesis of the maxilla was introduced for the successful maxillary advancement inthose kinds of patients. As both hard and soft tissues can be simultaneously and gradually extended with this technique, tensional force caused by heavy scars opposed to forward movement of the maxilla can be reduced to an extent not to develop severe relapse of the advanced maxilla. Since distraction osteogenesis of the maxilla was applied as one of standard protocols for the treatment of the patients with severe maxillary hypoplasia dueto cleft lip and/or palate, the devices for the distraction was improved to control the vectors of distraction with better and more stable. We have treated a 23-year-old male cleft patient with a severe maxillary hypoplasia using a newly developed a maxillary distraction device and a RP model for a pre-operative simulation surgery. As a result, we could successfully move the maxilla as we designed pre-operatively and also reduce much of operation time. Therefore, we report of the case to share our experience with colleagues.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제31권1호
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• pp.53-60
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• 2009

Maxillary deficiency, anterior cross bite, constriction of maxillary arch, malaligned teeth are frequently observed in patients with cleft lip and palate. Surgery and orthodontics, combined intervention are needed to correct maxillary deficiency. Distraction osteogenesis that currently used has many advantages like less relapse tendency, more advancement of maxilla, capable in growing patients. In case 1, 18 years old girl with BCLP had severe midfacial deficiency and multiple missing of teeth. LeFort I osteotomy, followed by maxillary distraction osteogenesis utilizing rigid external distraction device(RED) system, was performed. After a 6-day latency period, distraction proceeded at a rate of 1mm per day (at 1st week, 1.5mm/day). Total advancement was 19mm. The RED device left in place for the additional 4 weeks for consolidation. After the RED device was removed, face mask was applied with elastic traction for 5 weeks. After achieving acceptable facial appearance and occlusion, orthodontic appliance was removed. The results after 4 years follow-up was sustained pretty well without aggravation of velopharyngeal function. In case 2, 22 years old man with UCLP had severe midfacial deficiency and palatally erupted upper 2nd premolars due to arch length discrepancy, but the anterior segment of maxillary did not show constriction and crowding. patient had no arch width discrepancy, crowding was concentrated on premolar region. Segmental LeFort I osteotomy was performed. After a 6 - day latency period, using internal distraction device, distraction proceeded at a 0.5mm per day(at 1st week, 0.75 - 1 mm/day). Total advancement was 15mm. After internal distraction device was removed, face mask was applied with elastic traction for 4 weeks. After surgical-orthodontic treatment, facial appearance and occlusion was improved pretty good, and after 46 months follow-up the result was retained well.

• 대한치과의사협회지
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• 제55권12호
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• pp.870-882
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• 2017

Maxillary growth is hindered by the restricting pressure from the scar tissue formed after lip closure and palate closure surgeries of the cleft. Therefore, the anteroposterior skeletal relationship of both jaws exacerbates as patient grows. Conventional facemask treatment is valuable for dentoalveolar compensatory treatment and for very mild maxillary hypoplasia. To achieve further maxillary protraction, bone-anchored facemask or bone-anchored maxillary protraction can be attempted. For moderate maxillary hypoplasia, surgical orthodontic treatment after growth completion can be an efficient treatment reducing uncontrollable problems. For moderate to severe maxillary hypoplasia, distraction osteogenesis (DO) can be used alone or with later surgical orthodontic treatment. To compensate the severe relapse after DO, overcorrection and bone plate placement after DO are recommended. In case of hypernasality, maxillary anterior segmental distraction osteogenesis can be chosen to prevent exacerbation of the hypernasality.

• 대한치과교정학회지
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• 제32권3호
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• pp.175-183
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• 2002

Crouzon syndrome은 두 개융증, 상악골 형성부전증과 안구돌출증의 특징적인 제 가지 임상증상을 보이는 두개안면 증후군중 하나이다. 이러한 두개안면기형 환자를 치료하는 방법 중 요즘 점점 중요하게 떠오르는 방법이 distraction osteogenesis이다. 일반적인 악교정 수술에 비해 distraction osteogenesis는 여러 가지 장점이 존재한다. 심한 상악골 열 성장을 동반한 Crouzon syndrome환자의 상악골을 Le Fort III osteotomy후 RED system을 이용하여 성공적으로 전방 견인하여 심미 및 기능적으로 현저한 개선을 이룰 수 있었다.

• 대한구순구개열학회지
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• 제6권1호
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• pp.27-34
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• 2003

본 교실에서는 상악골의 열성장을 보이는 구순구개열환자에서 RED 장치를 이용한 골신장술을 통하여 상악골의 점진적인 전방이동을 실시하고 약 3년정도의 추시기간을 포함하는 현재까지 특별한 기능 장애없이 양호한상, 하악관계 및 안모를 보이는 증례를 문헌고찰과 함께 보고하는 바이다.

• 대한구순구개열학회지
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• 제8권2호
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• pp.71-79
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• 2005

Purpose: Maxillary hypoplasia is a common developmental problem of cleft lip and palate. Fair results with distraction osteogenesis have been reported especially when these patients need a large amount of maxillary advancement, instead of orthognathic surgery. The purpose of this study is to evaluate the clinical results with a relatively new distractor, $TS-MD^{(R)}$ (Trans-sinusoidal maxillary distractor, KLS Martin, Tuttlingen, Germany) which was used for the advancement of the maxilla in the cleft patients. Patients and Method: Distraction osteogenesis using $TS-MD^{(R)}$ was performed for four CLP patients (three males and one female) who had maxillary hypoplasia. All patients were over 16 years old. As three patients showed mandibular prognathism as well, bilateral sagittal split ramus osteotomy for mandibular setback was performed at the same time. After consolidation periods of 4 to 12 weeks, the distraction devices were removed and miniplates were placed for simultaneous internal fixation. Results: Three patients showed a large amount of incisal overbite but one patient did not have sufficient maxillary advancement. Le Fort I osteotomy, maxillary advancement and internal fixation should have been performed for the patient when removing the distraction devices. Different from the $clinician{\box}s$ expectation, the amount of maxillary advancement using $TS-MD^{(R)}$ was not sufficient, although the device has rigid mechanical property. Rotation of maxilla during distraction forward and downward was also observed. Conclusion: Even though the maxillary advancement with $TS-MD^{(R)}$ device could be achieved, the clinical control of some characteristics related with the device was necessary. More clinical studies on $TS-MD^{(R)}$ should be performed.

• 대한치과의사협회지
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• 제38권11호통권378호
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• pp.997-1007
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• 2000

Maxillary protraction is the treatment of choice for growing patients with skeletal Class 3 malocclusion due to midfacial retrusion. Its treatment goal is to achieve skeletal movement of maxilla without dentoalveolar movement. To avoid dentoalveolar movement, it is necessary to enhance anchorage of maxillary dentition or to reduce resistance of maxilla protraction. The purpose of this report is to introduce two cases applying adjunctive surgical approach as intentional ankylosis and distraction osteogenesis respectively.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제43권6호
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• pp.407-414
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• 2017

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.