To study the role of various surgical techniques for advancement in maxillary hypoplasia

Abstract

Introduction: Maxillary advancement in cleft lip and palate patients can be achieved using conventional le Fort I osteotomy and plate fixation or using distraction osteogenesis. Patient and Methods: 25 cleft lip and palate patients were surgically treated in Department of Oral and Maxillofacial Surgery at Dr.D.Y.Patil hospital between 2010 and 2014. They all presented with a midface hypoplasia and class III skeletal malocclusion. Patients with occlusal discrepancies larger than 6 mm and severe palatal scaring underwent Distraction osteogenesis (DO) to advance the maxilla. Patients with an occlusal discrepancy of 6 mm or less, underwent traditional orthognathic surgery including le fort I advancement and Bilateral sagittal split osteotomy (BSSO) to seat the mandible in occlusion. Results: Eleven patients underwent orthognathic surgery. Four of them underwent double jaw surgery. Four underwent single jaw conventional le fort l advancement. Four patients required bone grafting to repair the residual alveolar defect and to augment the midface deficiency. Fourteen patients with severe maxillary hypoplasia underwent maxillary advancement using distraction osteogenesis. Conclusion: Both techniques gave promising results provided having followed the proper selection criteria. Patients with a severe maxillary hypoplasia of 6 mm or more and excessive palatal scaring are better treated with DO whereas Conventional le Fort I gave better results for patients with less severe maxillary hypoplasia of less than 6 mm and less severe palatal scaring. Cleft lip and palate patients experience a high level of satisfaction with functional parameters and aesthetics after surgical-orthodontic treatment of maxillary hypoplasia.