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Outcome assessment on skeletal stability after rigid external distraction osteogenesis in cleft lip and palate patients

by Tabarini, Julio Enrique

Abstract (Summary)
Purpose: Distraction osteogenesis (DO) using an external distraction device in the correction of maxillary hypoplasia (MH) in cleft lip and palate patients has been shown to be an effective and stable technique. The purpose of this study is to determine the outcome of skeletal stability for this procedure using the Rigid External Distraction (RED) System in patients with cleft lip and palate (CLP). Materials and methods: Twenty CLP patients with moderate to severe maxillary hypoplasia were treated between June 2000 and June 2006. Their average age at the time of the surgery was 12.6 years. DO was started after a latency period of 5 to 7 days, after a high Le Fort I osteotomy at a rate of 0.5 mm twice a day for an average of 13.4 days. All patients use the RED, which was left in place for an additional period, averaging 3.8 weeks, to allow bony consolidation after the completion of DO. Once this was accomplished, the patient was placed on an orthodontic face mask with elastic traction for several weeks. Orthodontic treatment was then continued. The follow-up period averaged 24.8 months. The statistical analysis utilized in this study was a chi square test and t-test (for the means) with a p value < 0.05. Results: An average distraction of 12.0 mm was achieved for the time period from before to after distraction (T1-T2). A mean of 4.6 mm was lost in the period that correspond from after distraction to the last follow-up (T2-T3) and correspond to after DO to the last follow-up (mean 25 months). The net maxillary advancement from (T1 – T3) was 7.5 iii mm, corresponding to before DO to the last follow-up. The resulting relapse rate was 30 percent. Conclusions: Several factors may affect the results of the procedure, severity MH, type of cleft, speed of distraction, length of consolidation, length and use of face mask after RED removal, compliance of patients. Maxillary distraction osteogenesis using the RED has shown in several studies that is an effective and stable procedure in the correction of moderate to severe maxillary hypoplasia in cleft lip and palate patients when followed by further orthodontic night retention with facial mask for several weeks. It appears that greater anterior overcorrection of the hypoplastic maxilla is necessary to compensate for a partial relapse and growth deficit. iv
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Advisor:

School:University of Alabama at Birmingham

School Location:USA - Alabama

Source Type:Master's Thesis

Keywords:cleft lip palate malocclusion angle class iii maxilla oral surgical procedures osteogenesis distraction outcome assessment health care

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