Maxillary distraction osteogenesis and a Le Fort I osteotomy for severe maxillary retrognathia in cleft lip and palate: a case report
Publié en ligne: 20 juil. 2021
Pages: 205 - 210
Reçu: 01 janv. 2020
Accepté: 01 août 2020
DOI: https://doi.org/10.21307/aoj-2020-023
© 2020 Peter V. Fowler et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.
Background
The correction of severe maxillary retrognathia in patients presenting with a cleft palate is challenging due to the complexity of the orthodontic preparation and the magnitude of the surgical movements required, along with the relatively high risk of relapse.
Materials and methods
An 18-year-old Caucasian male with a repaired left-side unilateral cleft lip and palate presented with concerns relating to poor facial aesthetics and poor occlusion. Multidisciplinary treatment involving orthodontics and orthognathic surgery were undertaken to correct the severe maxillary retrognathia. The correction involved the use of internal distraction osteogenesis followed by a conventional maxillary Le Fort I advancement with rotation.
Results
Pre- and post-treatment lateral cephalogram measurements showed the maxilla was advanced 18 mm, rotated clockwise producing a 9 mm increase in vertical dimension at A point and a 7 mm gain in relative arch width across the first molars. Follow-up CBCT superimpositions showed excellent skeletal stability of the achieved anterior-posterior, lateral and vertical corrections over a 2.4-year period, although there was some minor dental relapse.
Conclusion
This case report illustrates the successful use of orthodontics and distraction osteogenesis followed by conventional Le Fort I advancement surgery to correct a severely retrognathic maxilla in a patient with a repaired unilateral cleft lip and palate.