Professor Yong-Deok KIM
金容德 教授
Pusan National University
Cleft lip and
palate(CLP) is the most frequent congenital facial abnormality. Cleft lip and
palate patients might have unfavorable smile esthetics and low self-esteem,
leading mainly to difficulties in social interactions. Moreover, patients with
CLP present typical characteristics, such as deficiency in midface development,
orthodontic Class III tendency, and significantly smaller ANB angle, presence
of oronasal fistula in some cases, alterations in shape and number of lateral incisors
and the presence of supernumerary teeth occasionally.
Since the 1970s, CLP deformities have conventionally been
corrected by orthognathic surgery, and since the late 1990s, distraction
osteogenesis has been recognized as an acceptable alternative for
treatment of maxillary hypoplasia in patients with CLP. But there are some
indications for distraction osteogenesis such as skeletal immaturity, requiring
advancement of more than 7mm of maxilla, severe fibrosis of lip and palate. So,
orthognathic surgery is usually the final phase of treatment for patients with
cleft lip and palate. The traditional surgical procedure for correcting
associated maxillary retrusion is a Le Fort I osteotomy.
In this presentation, I investigated various predisposing
factors influencing postoperative stability after orthognathic surgery in cleft
lip and palate patients. Preoperative and postoperative changes were compared
using cephalometrics for orthognathic surgery system to determine stability of
skeletal movement and quantity amount of relapse.
Distraction
osteogenesis has been extensively used to correct severe midface hypoplasia.
However few studies have reported midface distraction long term outcomes,
especially before teenagers through cephalometric evaluation. The second
purpose of the present study was to evaluate outcomes with midface distraction
rigid external device (RED) in young (before 12 years old) patients with cleft
lip and, in terms of quantity of bone lengthening, skeletal stability and
facial growth. Seven patients were retrospectively evaluated in this study.
Cephalometrics was carried out through three teleradiographies from each
patient (T0 -before surgery; T1- immediate postop, right after distracter
removal; T2- late postop, obtained with a minimal interval of 12 months after
surgery; T3 – before final orthognathic surgery; T4 – after orthognathic
surgery). Significant midface advancements were achieved with the procedures.
The rate of horizontal relapse was minimal. But we noticed all of patients’
positive overjets were relapsed after some periods and they needed to have
final orthognathic surgeries with bone graft or not. The periods which the
patients had class I key were short than expected by clinicians and at this
point the efficacy of this procedure was unclear for young cleft children.
Cephalometric evaluation showed inadequate results in midface bone lengthening
with rigid external distracter to children. Authors concluded that DO with RED
system was not recommended to young patients (before teenager) but to young adults.
