Download PDF
CC BY-NC-ND 4.0 · Eur J Dent 2018; 12(03): 393-397
DOI: 10.4103/ejd.ejd_374_17
Original Article
Dental Investigation Society

Cephalometric changes in nasopharyngeal area after anterior maxillary segmental distraction versus Le Fort I osteotomy in patients with cleft lip and palate

Soodeh Tahmasbi
1   Department of Orthodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
,
Abdolreza Jamilian
2   Department of Orthodontics, School of Dentistry, Islamic Azad University, Tehran, Iran
,
Rahman Showkatbakhsh
1   Department of Orthodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
,
Fereydoun Pourdanesh
3   Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
,
Mohammad Behnaz
1   Department of Orthodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
› Author Affiliations
Further Information

Publication History

Publication Date:
16 September 2019 (online)

   Permissions and Reprints

ABSTRACT

Objective: The present study was designed to compare the effects of two surgical methods, anterior maxillary segmental distraction (AMSD) versus conventional Le Fort I osteotomy, on cephalometric changes of velopharyngeal area of patients with cleft lip and palate. Materials and Methods: This study was conducted on 20 CLP in two groups. The first group had classic Le Fort I maxillary advancement and the second group had AMSD with a modified hyrax as an intraoral tooth-borne distractor. In the second group, 1 week after the surgery, activation of hyrax screw was started with the rate of 2 times a day for about 10 days. Initial and final lateral cephalograms were traced and analyzed by OrthoSurgerX software. Results: The changes in variables evaluating velopharyngeal status showed a significant difference between the two groups. In Group A (conventional), the mean of nasopharyngeal area and Nasopharynx floor length showed a significant increase (P < 0.05) after the surgery, while in Group B (DO), the trend of changes was vice-versa. The changes in SNA, overjet, and soft-tissue convexity were similar in both groups. Conclusion: AMSD can improve facial profile, almost similar to the conventional Le Fort I advancement, while there is a significant decrease in nasopharyngeal; hereby there is no increase in the velopharyngeal sphincter.

Key words:

Anterior maxillary segmental distraction - cleft lip and palate - velopharyngeal area
 

  • REFERENCES

  • 1 Cheung LK, Chua HD. A meta-analysis of cleft maxillary osteotomy and distraction osteogenesis. Int J Oral Maxillofac Surg 2006; 35: 14-24
    CrossrefPubMedGoogle Scholar
  • 2 Rao Janardhan S, Kotrashetti SM, Lingaraj JB, Pinto PX, Keluskar KM, Jain S. et al Anterior segmental distraction osteogenesis in the hypoplastic cleft maxilla: Report of five cases. Sultan Qaboos Univ Med J 2013; 13: 454-9
    PubMedGoogle Scholar
  • 3 Ross RB. Treatment variables affecting facial growth in complete unilateral cleft lip and palate. Cleft Palate J 1987; 24: 5-77
    PubMedGoogle Scholar
  • 4 Van Sickels JE. Distraction osteogenesis versus orthognathic surgery. Am J Orthod Dentofacial Orthop 2000; 118: 482-4
    CrossrefPubMedGoogle Scholar
  • 5 Gateno J, Engel ER, Teichgraeber JF, Yamaji KE, Xia JJ. A new le fort I internal distraction device in the treatment of severe maxillary hypoplasia. J Oral Maxillofac Surg 2005; 63: 148-54
    CrossrefPubMedGoogle Scholar
  • 6 Taha M, Elsheikh YM. Velopharyngeal changes after maxillary distraction in cleft patients using a rigid external distraction device: A retrospective study. Angle Orthod 2016; 86: 962-8
    CrossrefPubMedGoogle Scholar
  • 7 Maegawa J, Sells RK, David DJ. Pharyngoplasty in patients with cleft lip and palate after maxillary advancement. J Craniofac Surg 1998; 9: 330-5
    CrossrefPubMedGoogle Scholar
  • 8 Chanchareonsook N, Samman N, Whitehill TL. The effect of cranio-maxillofacial osteotomies and distraction osteogenesis on speech and velopharyngeal status: A critical review. Cleft Palate Craniofac J 2006; 43: 477-87
    CrossrefPubMedGoogle Scholar
  • 9 Chua HD, Whitehill TL, Samman N, Cheung LK. Maxillary distraction versus orthognathic surgery in cleft lip and palate patients: Effects on speech and velopharyngeal function. Int J Oral Maxillofac Surg 2010; 39: 633-40
    CrossrefPubMedGoogle Scholar
  • 10 Trindade IE, Yamashita RP, Suguimoto RM, Mazzottini R, Trindade Jr AS. Effects of orthognathic surgery on speech and breathing of subjects with cleft lip and palate: Acoustic and aerodynamic assessment. Cleft Palate Craniofac J 2003; 40: 54-64
    CrossrefPubMedGoogle Scholar
  • 11 Witzel MA, Munro IR. Velopharyngeal insufficiency after maxillary advancement. Cleft Palate J 1977; 14: 176-80
    PubMedGoogle Scholar
  • 12 Satoh K, Nagata J, Shomura K, Wada T, Tachimura T, Fukuda J. et al. Morphological evaluation of changes in velopharyngeal function following maxillary distraction in patients with repaired cleft palate during mixed dentition. Cleft Palate Craniofac J 2004; 41: 355-63
    CrossrefPubMedGoogle Scholar
  • 13 Bengi O, Karaçay S, Akin E, Okçu KM, Olmez H, Mermut S. et al Cephalometric evaluation of patients treated by maxillary anterior segmental distraction: A preliminary report. J Craniomaxillofac Surg 2007; 35: 302-10
    CrossrefPubMedGoogle Scholar
  • 14 Block MS, Brister GD. Use of distraction osteogenesis for maxillary advancement: Preliminary results. J Oral Maxillofac Surg 1994; 52: 282-6
    CrossrefPubMedGoogle Scholar
  • 15 Dolanmaz D, Karaman AI, Ozyesil AG. Maxillary anterior segmental advancement by using distraction osteogenesis: A case report. Angle Orthod 2003; 73: 201-5
    PubMedGoogle Scholar
  • 16 Gunaseelan R, Cheung LK, Krishnaswamy R, Veerabahu M. Anterior maxillary distraction by tooth-borne palatal distractor. J Oral Maxillofac Surg 2007; 65: 1044-9
    CrossrefPubMedGoogle Scholar
  • 17 Alkan A, Baş B, Ozer M, Bayram M, Yüzbasioǧlu E. Maxillary anterior segmental advancement of hypoplastic maxilla in cleft patients by distraction osteogenesis: Report of 2 cases. J Oral Maxillofac Surg 2008; 66: 126-32
    PubMedGoogle Scholar
  • 18 Gualini C. Advancement of maxillary anterior segment by distraction osteogenesis (DO): A case report. Prog Orthod 2007; 8: 54-61
    Google Scholar
  • 19 Wang XX, Wang X, Li ZL, Yi B, Liang C, Jia YL. et al. Anterior maxillary segmental distraction for correction of maxillary hypoplasia and dental crowding in cleft palate patients: A preliminary report. Int J Oral Maxillofac Surg 2009; 38: 1237-43
    CrossrefPubMedGoogle Scholar
  • 20 Showkatbakhsh R, Pourdanesh F, Jamilian A, Ghorbani A, Behnaz M. Hyrax application as a tooth-borne distractor for maxillary advancement. J Craniofac Surg 2011; 22: 1361-6
    CrossrefPubMedGoogle Scholar
  • 21 Nouri M, Alijani S, Akbarzade A. Changes in craniofacial morphology, head and neck posture following mandibular setback surgery. Iran J Orthod 2013; 8: 47-56
    Google Scholar
  • 22 Linder-Aronson S, Henrikson CO. Radiocephalometric analysis of anteroposterior nasopharyngeal dimensions in 6-to 12-year-old mouth breathers compared with nose breathers. ORL J Otorhinolaryngol Relat Spec 1973; 35: 19-29
    CrossrefPubMedGoogle Scholar
  • 23 Tobias PV. The nasopharynx: Review of structure and development, with notes on speech, pharyngeal hypophysis, chordoma and the dens. J Dent Assoc S Afr 1981; 36: 765-78
    PubMedGoogle Scholar
  • 24 Bergland O. The bony nasopharynx. A roentgen-craniometric study. Acta Odontol Scand 1963; 21 (Suppl. 35) 1-137
    CrossrefPubMedGoogle Scholar
  • 25 Guyette TW, Polley JW, Figueroa A, Smith BE. Changes in speech following maxillary distraction osteogenesis. Cleft Palate Craniofac J 2001; 38: 199-205
    CrossrefPubMedGoogle Scholar
  • 26 Okcu KM, Sencimen M, Karacay S, Bengi AO, Ors F, Dogan N. et al. Anterior segmental distraction of the hypoplastic maxilla by a tooth borne device: A study on the movement of the segment. Int J Oral Maxillofac Surg 2009; 38: 817-22
    CrossrefPubMedGoogle Scholar
  • 27 Karakasis D, Hadjipetrou L. Advancement of the anterior maxilla by distraction (case report). J Craniomaxillofac Surg 2004; 32: 150-4
    CrossrefPubMedGoogle Scholar
  • 28 Aikawa T, Haraguchi S, Tanaka S, Uematsu S, Ishibashi M, Kogo M. et al. Rotational movement of the anterior maxillary segment by hybrid distractor in patients with cleft lip and palate. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010; 110: 292-300
    CrossrefPubMedGoogle Scholar
  • 29 Kummer AW, Strife JL, Grau WH, Creaghead NA, Lee L. The effects of le fort I osteotomy with maxillary movement on articulation, resonance, and velopharyngeal function. Cleft Palate J 1989; 26: 193-9
    PubMedGoogle Scholar
  • 30 Schendel SA, Oeschlaeger M, Wolford LM, Epker BN. Velopharyngeal anatomy and maxillary advancement. J Maxillofac Surg 1979; 7: 116-24
    CrossrefPubMedGoogle Scholar
  • 31 Ko EW, Figueroa AA, Guyette TW, Polley JW, Law WR. Velopharyngeal changes after maxillary advancement in cleft patients with distraction osteogenesis using a rigid external distraction device: A 1-year cephalometric follow-up. J Craniofac Surg 1999; 10: 312-20
    CrossrefPubMedGoogle Scholar