Orthognathic treatment (applicable for facial cleft deformities)
Orthognathic repair for cleft deformities - The ULTIMATE Clinical pearls, continued 5. Distraction osteogenesis in children between 5 - 12 years of age may initially result in perfect facial harmony. However, the midface (in CLAP, hPsP, sP cases) and the mandible (in lateral facial cleft and FRT and SRS cases) quite often do not grow sufficiently until the age of 14 years. Therefore, in order to achieve the best possible aesthetic and functional result, a second distraction osteogenesis or conventional orthognathic surgery might be indicated in patients of 14 years of age or older. 6. Hypoplastic maxillae can be corrected by internal or external distraction. Internal distraction provides less accurate maxillary movement, eventually with more unexpected superior, inferior or lateral rotational directions. Such unexpected movements might occur either due to accidental plate bending during the distraction procedure or due to impingement between the distractor rod and mandibular coronoid process. 7. Cranio-maxillary or external distraction provides better control of the maxillary distraction vector. Further maxillary vertical tilting can be controlled simultaneously to anterior distraction using a 3-D cranio-maxillary distractor. This facilitates the treatment of maxillary anterior open bite (apertognathia). An ideal occlusion can be achieved by callus manipulation with orthodontic elastics after the removal of the distraction device.
Book: Cleft Ultimate Treatment -- Oro-facial and Cranio-maxillo-facial Deformities (Second Edition) Authors: Dr. Kurt Butow and Dr. Roger Z...