Cleft distraction versus orthognathic surgery - which is more stable?

Abstract

Introduction: Distraction osteogenesis has opened new perspective for the treatment of various skeletal anomalies, particularly for the cleft lip and palate patients. Objective: To compare the stability of maxillary Le Fort I advancement in CLP patients by either distraction with internal distractors or immediate transposition with titanium plate fixation. Methods: Fourty CLP patients with moderate maxillary hypoplasia requiring a Le Fort I advancement of 4–10 mm were randomized to either distraction or immediate fragment transposition. The conventional Le Fort I osteotomy was fully mobilized to the pre-planned position and fixed using titanium mini-plates. The Le Fort I distraction was only mobilized to a limited extent without achieving the final surgical position. Fixation was achieved on the zygoma and the molar alveolus with an intra-oral bone-borne maxillary distractor on each side. Results: The mean advancement for the distraction group and the osteotomy group was 6.83 and 6.72 mm, respectively. In the osteotomy group a relapse of both A-point and P-point in the upward and backward direction of 15% was noted between the 2nd and 8th week post-operatively. In contrast, the A-point moved further forward by 30% and downward by 25% at the same interval in the distraction group. The results were statistically significant between the two groups (p <0.05). Conclusion: The result of this study showed that distraction of the cleft maxilla demonstrated better skeletal stability in maintaining its advanced position than conventional orthognathic surgery particularly in the early post-operative 3 months.