CLEFT MAXILLARY HYPOPLASIA: A REVIEW OF TREATMENT OPTIONS
Keywords:
Cleft maxillary hypoplasia, face mask, orthognathic surgery, distraction osteogenesis, anterior maxillary distraction
Abstract
Maxillary hypoplasia is a frequently observed secondary deformity in individuals born with cleft lip and palate. The impairment of maxillary growth coupled with extensive postoperative scarring as a result of multiple previous surgeries brings about maxillary deficiency in all planes viz vertical, horizontal and transverse. The resulting class III skeletal malocclusion together with maxillary hypoplasia produces structural imbalance, functional insufficiency, and aesthetic disharmony. Two types of options are available to manage this deformity viz non-surgical and surgical. The non-surgical options include Orthodontics alone or orthopedic protraction using face mask/ reverse pull headgear. The surgical options include conventional orthognathic surgery at Lefort I level or distraction osteogenesis either complete or anterior maxillary distraction. This article highlights all the options available for managing this complex deformity. An effort has also been made to highlight the merits and demerits of each procedure as well as its adverse effects on speech present if any.
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References
1. Liao YF, Mars M. Long-term effects of lip repair on dentofacial morphology in patients with unilateral cleft lip and palate. Cleft Palate Craniofac J. 2005;42: 526–32.
2. Ross RB: Treatment variables affecting facial growth in complete unilateral cleft lip and palate. Cleft Palate J. 24(1):5-77, 1987
3. Steinberg B, Padwa BL, Boyne P, Kaban L. State of the art in oral and maxillofacial surgery: treatment of maxillary hypoplasia and anterior palatal and alveolar clefts. Cleft Palate Craniofac J. 2000; 37:421–422.
4. Yen SLK. Protocols for late maxillary protraction in cleft lip and palate patients at Children's Hospital Los Angeles. Semin Orthod 2011; 17: 138-48.
5. Dogan S. The effects of face mask therapy in cleft lip and palate patients. Ann Maxillofac Surg 2012; 2: 116-20.
6. Suryawanshi GR, Philip K, Kumar S. Treatment of maxillary hypoplasia in skeletal class III patient. Dentistry 2014; 4: 1-5.
7. Molina F, Ortiz Monasterio F, de la Paz Aguilar M et al. Maxillary distraction: aesthetic and functional benefits in cleft lip palate and prognathic patients during mixed dentition. Plast Recontr Surg 1998; 101: 951-63
8. McNamara JA Jr. An orthopedic approach to the treatment of Class III malocclusion in young patients. J Clin Orthod 1987; 21: 598-608.
9. da Silva Filho OG, Magro AC, Capelozza Filho L. Early treatment of the Class III malocclusion with rapid maxillary expansion and maxillary protraction. Am J Orthod Dentofacial Orthop 1998; 113: 196-203.
10. Baccetti T, McGill JS, Franchi L, McNamara JA Jr, Tollaro I. Skeletal effects of early treatment of Class III malocclusion with maxillary expansion and facemask therapy. Am J Orthod Dentofacial Orthop 1998; 113: 333-343.
11. Ngan PW, Hagg U, Yiu C, Wei SH. Treatment response and long-term dentofacial adaptations to maxillary expansion and protraction. Semin Orthod. 1997;3:255–64.
12. Baccetti T, Franchi L, McNamara JA Jr. Treatment and posttreatment craniofacial changes after rapid maxillary expansion and facemask therapy. Am J Orthod Dentofacial Orthop. 2000;118:404–13
13. Ngan P, Hägg U, Yiu C, Merwin D, Wei SH. Soft tissue and endoskeletal profile changes associated with maxillary expansion and protraction headgear treatment. Am J Orthod Dentofacial Orthop. 1996;109:38–49.
14. Ngan P, Yiu C, Hu A, Hägg U, Wei SH, Gunel E. Cephalometric and occlusal changes following maxillary expansion and protraction. Eur J Orthod. 1998;20:237–54.
15. Kokich VG, Shapiro PA, Oswald R, Koskinen-Moffett L, Clarren SK. Ankylosed teeth as abutments for maxillary protraction: A case report. Am J Orthod. 1985;88:303–7.
16. Smalley WM, Shapiro PA, Hohl TH, Kokich VG, Branemark P. Osseointegrated titanium implants for maxillofacial protraction in monkeys. Am J Orthod Dentofacial Orthop. 1988;94:285–95.
17. Singer SL, Henry PJ, Rosenberg I. Osseointegrated implants as an adjunct to face mask therapy: A case report. Angle Orthod. 2000;70:253–62.
18. Hong H, Ngan P, Han G, Qi LG, Wei SH. Use of plants as a stable anchorage for face mask treatment: A case report. Angle Orthod. 2005;75:453–60.
19. Kircelli BH, Pektas ZO. Midfacial protraction with skeletally anchored face mask therapy: A novel approach and preliminary results. Am J Orthod Dentofacial Orthop. 2008; 133:440–9.
20. Gautam P, Valiathan A, Adhikari R. Skeletal response to maxillary protraction with and without maxillary expansion: A finite element study. Am J Orthod Dentofacial Orthop. 2009; 135: 723–8.
21. Vachiramon A, Urata M, Kyung HM, Yamashita DD, Yen SL. Clinical applications of orthodontic micro implant anchorage in craniofacial patients. Cleft Palate Craniofac J. 2009; 46:136–46.
22. Baek SH, Kim KW, Choi JY. New treatment modality for maxillary hypoplasia in cleft patients. Protraction face mask with mini plate anchorage. Angle Orthod. 2010;80:595–603.
23. Lee NK, Baek SH. Stress and displacement between maxillary protraction with mini plates placed at the infra zygomatic crest and the lateral nasal wall: A 3-dimensional finite element analysis. Am J Orthod Dentofacial Orthop. 2012;141:345–51.
24. Cohen SR, Corrigan M, Wilmot J, et al. Cumulative operative procedures in patients aged 14 years and older with unilateral or bilateral cleft lip and palate. Plast Reconstr Surg 1995;96:267-271
25. Rosenstein S, Kernahan D, Dado D, et al. Orthognathic surgery in cleft patients treated by early bone grafting. Plast Reconstr Surg 1991;87:835-892
26. De Luke DM, Marchand A, Robles EC, et al. Facial growth and the need for orthognathic surgery after cleft palate repair: literature review and report of 28 cases. J Oral Maxillofac Surg 1997;55:694-697
27. Hirano A, Suzuki H: Factors Related to Relapse After Le Fort I Maxillary Advancement Osteotomy in Patients With Cleft Lip and Palate. Cleft Palate Craniofac J 2001; 38:1-10.
28. Combs PD, Harshbarger RJ. Lefort I maxillary advancement using distraction osteogenesis. Semin Plast Surg 2005; 28: 193-98.
29. Rachmiel A. Treatment of maxillary cleft palate: distraction osteogenesis versus orthognathic surgery—part one: maxillary distraction. J Oral Maxillofac Surg 2007;65(4):753–757
30. Posnick JC, Dagys AP. Skeletal stability and relapse patterns after Le Fort I maxillary osteotomy fixed with mini plates: the unilateral cleft lip and palate deformity. Plast Reconstr Surg 1994;94(7): 924–932
31. Janulewicz J, Costello BJ, Buckley MJ, et al: The effects of Le Fort I osteotomies on velopharyngeal and speech functions in cleft patients. J Oral Maxillofac Surg 2004; 62:308
32. Chanchareonsook N, Whitehill TL, Samman N: Speech outcome and velopharyngeal function in cleft palate: Comparison of Le Fort I maxillary osteotomy and distraction osteogenesis— Early results. Cleft Palate Craniofac J 2007; 44:23
33. Chua HD, Whitehill TL, Samman N et al. 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.
34. Polley JW, Figueroa AA. Management of severe maxillary deficiency in childhood and adolescence through distraction osteogenesis with an external, adjustable, rigid distraction device. J Craniofac Surg 1997;8(3):181–185.
35. Yamaji KE, Gateno J, Xia JJ, Teichgraeber JF. New internal Le Fort I distractor for the treatment of midface hypoplasia. J Craniofac Surg 2004;15:124–127.
36. Scolozzi P. Distraction osteogenesis in the management of severe maxillary hypoplasia in cleft lip and palate patients. J Craniofac Surg 2008;19(5):1199–1214
37. Polley JW, Figueroa AA. Rigid external distraction: its application in cleft maxillary deformities. Plast Reconstr Surg 1998;102(5): 1360– 1372.
38. Semb G. A study of facial growth in patients with unilateral cleft lip and palate treated by the Oslo CLP Team. Cleft Palate Craniofac J 1991;28(1):1–21.
39. da Silva Filho OG, Normando AD, Capelozza Filho L. Mandibular growth in patients with cleft lip and/or cleft palate—the influence of cleft type. Am J Orthod Dentofacial Orthop 1993;104(3): 269–275
40. Cho BC, Kyung HM. Distraction osteogenesis of the hypoplastic midface using a rigid external distraction system: the results of a oneto six-year follow-up. Plast Reconstr Surg 2006;118(5): 1201–1212
41. Kanno T, Mitsugi M, Hosoe M, Sukegawa S, Yamauchi K, Furuki Y. Long-term skeletal stability after maxillary advancement with distraction osteogenesis in nongrowing patients. J Oral Maxillofac Surg 2008;66(9):1833–1846
42. Wiltfang J, Hirschfelder U, Neukam FW, Kessler P. Long-term results of distraction osteogenesis of the maxilla and midface. Br J Oral Maxillofac Surg 2002;40(6):473–479
43. Aksu M, Saglam-Aydinatay B, Akcan CA, et al. Skeletal and dental stability after maxillary distraction with a rigid external device in the adult cleft lip and palate patients. J Oral Maxillofac Surg 2010; 68(2):254–259
44. Gürsoy S, Hukki J, Hurmerinta K. Five-year follow-up of maxillary distraction osteogenesis on the dentofacial structures of children with cleft lip and palate. J Oral Maxillofac Surg 2010;68(4): 744–750
45. Rachmiel A, Aizenbud D, Peled M. Long-term results in maxillary deficiency using intraoral devices. Int J Oral Maxillofac Surg 2005; 34(5):473– 479.
46. Cheung LK, Chua HD. A metaanalysis of cleft maxillary osteotomy and distraction osteogenesis. Int J Oral Maxillofac Surg 2006; 35(1):14–24
47. Rachmiel A, Potparic Z, Jackson IT et al. Midface advancement by gradual distraction. Br J Plast Surg 1993; 46:201.
48. Kumar A, Gabbay JS, Nikloo R et al. Improved outcomes in cleft patients with severe maxillary deficiency after Lefort I internal distraction. Plast Recoonstr Surg 2006; 117: 1499.
49. Plazaa AM, Nunez MM: Maxillary advancement in cleft palate patients with intraoral distraction. Rev Esp Cir Oral Maxillofac 2015 .;37(3):123–131.
50. Dolanmaz D, Karaman AI, Ozyesil AG. Maxillary anterior segmental advancement using distraction osteogenesis. A case report. Angle Orthod 2003; 73: 201.
51. Wang XX, Wang X, Z.-L.Li, B. Yi, C. Liang, Y.L.Jia, B.S.Zou: 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
52. Richardson S, Seelan N, Selvaraj D, Khandeparker R, Gnanamony S: Perceptual Speech Assessment After Anterior Maxillary Distraction in Patients With Cleft Maxillary Hypoplasia. J Oral Maxillofac Surg 2016; 74:1239.e1-1239.e9.
53. Richardson S, Selvaraj D, Khandeparker R, Seelan N, Richardson S: Tooth-Borne Anterior Maxillary Distraction for Cleft Maxillary Hypoplasia: Our Experience With 147 Patients.J Oral Maxillofac Surg 2016; 74:2504.e1-2504.e14.
2. Ross RB: Treatment variables affecting facial growth in complete unilateral cleft lip and palate. Cleft Palate J. 24(1):5-77, 1987
3. Steinberg B, Padwa BL, Boyne P, Kaban L. State of the art in oral and maxillofacial surgery: treatment of maxillary hypoplasia and anterior palatal and alveolar clefts. Cleft Palate Craniofac J. 2000; 37:421–422.
4. Yen SLK. Protocols for late maxillary protraction in cleft lip and palate patients at Children's Hospital Los Angeles. Semin Orthod 2011; 17: 138-48.
5. Dogan S. The effects of face mask therapy in cleft lip and palate patients. Ann Maxillofac Surg 2012; 2: 116-20.
6. Suryawanshi GR, Philip K, Kumar S. Treatment of maxillary hypoplasia in skeletal class III patient. Dentistry 2014; 4: 1-5.
7. Molina F, Ortiz Monasterio F, de la Paz Aguilar M et al. Maxillary distraction: aesthetic and functional benefits in cleft lip palate and prognathic patients during mixed dentition. Plast Recontr Surg 1998; 101: 951-63
8. McNamara JA Jr. An orthopedic approach to the treatment of Class III malocclusion in young patients. J Clin Orthod 1987; 21: 598-608.
9. da Silva Filho OG, Magro AC, Capelozza Filho L. Early treatment of the Class III malocclusion with rapid maxillary expansion and maxillary protraction. Am J Orthod Dentofacial Orthop 1998; 113: 196-203.
10. Baccetti T, McGill JS, Franchi L, McNamara JA Jr, Tollaro I. Skeletal effects of early treatment of Class III malocclusion with maxillary expansion and facemask therapy. Am J Orthod Dentofacial Orthop 1998; 113: 333-343.
11. Ngan PW, Hagg U, Yiu C, Wei SH. Treatment response and long-term dentofacial adaptations to maxillary expansion and protraction. Semin Orthod. 1997;3:255–64.
12. Baccetti T, Franchi L, McNamara JA Jr. Treatment and posttreatment craniofacial changes after rapid maxillary expansion and facemask therapy. Am J Orthod Dentofacial Orthop. 2000;118:404–13
13. Ngan P, Hägg U, Yiu C, Merwin D, Wei SH. Soft tissue and endoskeletal profile changes associated with maxillary expansion and protraction headgear treatment. Am J Orthod Dentofacial Orthop. 1996;109:38–49.
14. Ngan P, Yiu C, Hu A, Hägg U, Wei SH, Gunel E. Cephalometric and occlusal changes following maxillary expansion and protraction. Eur J Orthod. 1998;20:237–54.
15. Kokich VG, Shapiro PA, Oswald R, Koskinen-Moffett L, Clarren SK. Ankylosed teeth as abutments for maxillary protraction: A case report. Am J Orthod. 1985;88:303–7.
16. Smalley WM, Shapiro PA, Hohl TH, Kokich VG, Branemark P. Osseointegrated titanium implants for maxillofacial protraction in monkeys. Am J Orthod Dentofacial Orthop. 1988;94:285–95.
17. Singer SL, Henry PJ, Rosenberg I. Osseointegrated implants as an adjunct to face mask therapy: A case report. Angle Orthod. 2000;70:253–62.
18. Hong H, Ngan P, Han G, Qi LG, Wei SH. Use of plants as a stable anchorage for face mask treatment: A case report. Angle Orthod. 2005;75:453–60.
19. Kircelli BH, Pektas ZO. Midfacial protraction with skeletally anchored face mask therapy: A novel approach and preliminary results. Am J Orthod Dentofacial Orthop. 2008; 133:440–9.
20. Gautam P, Valiathan A, Adhikari R. Skeletal response to maxillary protraction with and without maxillary expansion: A finite element study. Am J Orthod Dentofacial Orthop. 2009; 135: 723–8.
21. Vachiramon A, Urata M, Kyung HM, Yamashita DD, Yen SL. Clinical applications of orthodontic micro implant anchorage in craniofacial patients. Cleft Palate Craniofac J. 2009; 46:136–46.
22. Baek SH, Kim KW, Choi JY. New treatment modality for maxillary hypoplasia in cleft patients. Protraction face mask with mini plate anchorage. Angle Orthod. 2010;80:595–603.
23. Lee NK, Baek SH. Stress and displacement between maxillary protraction with mini plates placed at the infra zygomatic crest and the lateral nasal wall: A 3-dimensional finite element analysis. Am J Orthod Dentofacial Orthop. 2012;141:345–51.
24. Cohen SR, Corrigan M, Wilmot J, et al. Cumulative operative procedures in patients aged 14 years and older with unilateral or bilateral cleft lip and palate. Plast Reconstr Surg 1995;96:267-271
25. Rosenstein S, Kernahan D, Dado D, et al. Orthognathic surgery in cleft patients treated by early bone grafting. Plast Reconstr Surg 1991;87:835-892
26. De Luke DM, Marchand A, Robles EC, et al. Facial growth and the need for orthognathic surgery after cleft palate repair: literature review and report of 28 cases. J Oral Maxillofac Surg 1997;55:694-697
27. Hirano A, Suzuki H: Factors Related to Relapse After Le Fort I Maxillary Advancement Osteotomy in Patients With Cleft Lip and Palate. Cleft Palate Craniofac J 2001; 38:1-10.
28. Combs PD, Harshbarger RJ. Lefort I maxillary advancement using distraction osteogenesis. Semin Plast Surg 2005; 28: 193-98.
29. Rachmiel A. Treatment of maxillary cleft palate: distraction osteogenesis versus orthognathic surgery—part one: maxillary distraction. J Oral Maxillofac Surg 2007;65(4):753–757
30. Posnick JC, Dagys AP. Skeletal stability and relapse patterns after Le Fort I maxillary osteotomy fixed with mini plates: the unilateral cleft lip and palate deformity. Plast Reconstr Surg 1994;94(7): 924–932
31. Janulewicz J, Costello BJ, Buckley MJ, et al: The effects of Le Fort I osteotomies on velopharyngeal and speech functions in cleft patients. J Oral Maxillofac Surg 2004; 62:308
32. Chanchareonsook N, Whitehill TL, Samman N: Speech outcome and velopharyngeal function in cleft palate: Comparison of Le Fort I maxillary osteotomy and distraction osteogenesis— Early results. Cleft Palate Craniofac J 2007; 44:23
33. Chua HD, Whitehill TL, Samman N et al. 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.
34. Polley JW, Figueroa AA. Management of severe maxillary deficiency in childhood and adolescence through distraction osteogenesis with an external, adjustable, rigid distraction device. J Craniofac Surg 1997;8(3):181–185.
35. Yamaji KE, Gateno J, Xia JJ, Teichgraeber JF. New internal Le Fort I distractor for the treatment of midface hypoplasia. J Craniofac Surg 2004;15:124–127.
36. Scolozzi P. Distraction osteogenesis in the management of severe maxillary hypoplasia in cleft lip and palate patients. J Craniofac Surg 2008;19(5):1199–1214
37. Polley JW, Figueroa AA. Rigid external distraction: its application in cleft maxillary deformities. Plast Reconstr Surg 1998;102(5): 1360– 1372.
38. Semb G. A study of facial growth in patients with unilateral cleft lip and palate treated by the Oslo CLP Team. Cleft Palate Craniofac J 1991;28(1):1–21.
39. da Silva Filho OG, Normando AD, Capelozza Filho L. Mandibular growth in patients with cleft lip and/or cleft palate—the influence of cleft type. Am J Orthod Dentofacial Orthop 1993;104(3): 269–275
40. Cho BC, Kyung HM. Distraction osteogenesis of the hypoplastic midface using a rigid external distraction system: the results of a oneto six-year follow-up. Plast Reconstr Surg 2006;118(5): 1201–1212
41. Kanno T, Mitsugi M, Hosoe M, Sukegawa S, Yamauchi K, Furuki Y. Long-term skeletal stability after maxillary advancement with distraction osteogenesis in nongrowing patients. J Oral Maxillofac Surg 2008;66(9):1833–1846
42. Wiltfang J, Hirschfelder U, Neukam FW, Kessler P. Long-term results of distraction osteogenesis of the maxilla and midface. Br J Oral Maxillofac Surg 2002;40(6):473–479
43. Aksu M, Saglam-Aydinatay B, Akcan CA, et al. Skeletal and dental stability after maxillary distraction with a rigid external device in the adult cleft lip and palate patients. J Oral Maxillofac Surg 2010; 68(2):254–259
44. Gürsoy S, Hukki J, Hurmerinta K. Five-year follow-up of maxillary distraction osteogenesis on the dentofacial structures of children with cleft lip and palate. J Oral Maxillofac Surg 2010;68(4): 744–750
45. Rachmiel A, Aizenbud D, Peled M. Long-term results in maxillary deficiency using intraoral devices. Int J Oral Maxillofac Surg 2005; 34(5):473– 479.
46. Cheung LK, Chua HD. A metaanalysis of cleft maxillary osteotomy and distraction osteogenesis. Int J Oral Maxillofac Surg 2006; 35(1):14–24
47. Rachmiel A, Potparic Z, Jackson IT et al. Midface advancement by gradual distraction. Br J Plast Surg 1993; 46:201.
48. Kumar A, Gabbay JS, Nikloo R et al. Improved outcomes in cleft patients with severe maxillary deficiency after Lefort I internal distraction. Plast Recoonstr Surg 2006; 117: 1499.
49. Plazaa AM, Nunez MM: Maxillary advancement in cleft palate patients with intraoral distraction. Rev Esp Cir Oral Maxillofac 2015 .;37(3):123–131.
50. Dolanmaz D, Karaman AI, Ozyesil AG. Maxillary anterior segmental advancement using distraction osteogenesis. A case report. Angle Orthod 2003; 73: 201.
51. Wang XX, Wang X, Z.-L.Li, B. Yi, C. Liang, Y.L.Jia, B.S.Zou: 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
52. Richardson S, Seelan N, Selvaraj D, Khandeparker R, Gnanamony S: Perceptual Speech Assessment After Anterior Maxillary Distraction in Patients With Cleft Maxillary Hypoplasia. J Oral Maxillofac Surg 2016; 74:1239.e1-1239.e9.
53. Richardson S, Selvaraj D, Khandeparker R, Seelan N, Richardson S: Tooth-Borne Anterior Maxillary Distraction for Cleft Maxillary Hypoplasia: Our Experience With 147 Patients.J Oral Maxillofac Surg 2016; 74:2504.e1-2504.e14.
How to Cite
1.
Purva Khandeparker, Rakshit Khandeparker, Saurabh Kamat, Omkar Shetye. CLEFT MAXILLARY HYPOPLASIA: A REVIEW OF TREATMENT OPTIONS. Med. res. chronicles [Internet]. 2017Oct.31 [cited 2024May6];4(05):501-7. Available from: https://medrech.com/index.php/medrech/article/view/266
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Review Article
