Abstract Objectives: 1. To compare the surgical treatment methods of ...

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Part II: Cleft Maxillary Distraction versus Orthognathic Surgery: Clinical Morbidities and Surgical Relapse 29 CLP patients with diagnosis of moderate maxillary hypoplasia underwent Le Fort I osteotomy requiring an advancement of 4-10 mm were randomized to either for distraction or immediate maxillary transposition. In the distraction group, active distraction was commenced at day - 3 after distractor insertion at a rate of 1mm per day until achieving a class I incisor relationship. The distractors were removed around the third post-operative month. In the osteotomy group, the cleft maxilla was mobilized to the pre-planned class I occlusion during the operation and then fixed by 4 titanium mini-plates and screws. The clinical morbidities were recorded by standardized questionnaires during operation and post-operatively at 2 and 8 weeks, 3, 6 and 12 months. Skeletal and dental relapse were assessed by using lateral cephalographs taken pre-operatively and post-operatively at the same interval. Serial comparisons of dental and skeletal cephalometric landmarks were used for the determination of surgical relapse. Result: Part I: This search revealed 98 articles. 72 articles were related to cleft maxillary osteotomy and 26 were related to cleft maxillary distraction. This review revealed that 1418 cleft patients underwent maxillary osteotomy and 276 patients underwent distraction osteogenesis. The surgical planning of the two groups studied was similar. The reported surgical movement in the distraction group was mainly in the anterior-posterior as well as some also in the transverse plane. In the osteotomy group, it was only in antero-posterior and vertical planes. The amount of
advancement achieved in both groups was quite similar. However, the maximum amount of movement reported for distraction was larger. Part II: In the distraction group, two patients developed mucosal infection around the distractors and one has occlusal relapse, whereas in the osteotomy group, one patient encountered haemorrhage from transection of the descending palatine vessels during maxillary mobilization, one patient had exposure of plate leading to sinusitis and one patient developed occlusal relapse. For the skeletal relapse of the osteotomy group, a vertical relapse of A-point in upward direction was noted between the 2 nd - 8 th week and 8 th -12 th week post-operatively of 6% and 33%, respectively. In contrast, the A-point moved further downward by 15% and 10% at the same interval in the distraction group. In the horizontal relapse of A and P-points, a backward surgical relapse of 21% and 13% was found, whereas in the distraction group, both points moved further forward for 25% and 15% during the 8 th – 12 th weeks post-operatively. The results were statistically significant between the two groups. Conclusion: Part I: The literature review revealed that patients who had distraction osteogenesis were younger than those who had orthognathic surgery. The amount of advancement was significantly greater in distraction as compared to that of the conventional osteotomy. There is however lack of good data on long term results and relapse on distraction osteogenesis when compared with conventional osteotomy in CLP
Page 1: Abstract Objectives: 1. To compare

Abstract Objectives: 1. To compare the surgical treatment methods of ...

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