Distraction or orthognathic surgery for cleft palate deformities - which is better?

Abstract

Maxillary hypoplasia leading to a sunken midface is a common developmental problem in cleft lip and palate (CLP) patients. These deformities were corrected by orthognathic surgery traditionally from 1970 – 90s. However, this type of immediate transposition of the cleft maxilla is technically difficult due to severe deformity demanding large surgical movement and the tension from the palatal scar. Distraction osteogenesis, the process of generating new bone through gradual traction between two surgically separated segments fixed to a mechanical device, has become increasingly popular. It has opened new perspective for the treatment of various skeletal anomalies, particularly for the cleft lip and palate patients. A comprehensive literature review of orthognathic surgery and distraction osteogenesis for the treatment of maxillary hypoplasia in patients with cleft lip and palate deformities will be presented. The difference in the indications, surgical relapse, complications, soft tissue changes, and velopharyngeal changes from both surgical methods will be discussed. The current results of our randomized clinical trial focused on the morbidity, surgical relapse, soft tissue changes as well as psychological changes of CLP patients will also be presented.