ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
View the CAT printer-friendly / share this CAT
spacer
Title Greater Skeletal Stability in Maxillary Distraction of Cleft Treated Patients Compared to Conventional Osteotomy
Clinical Question Does the incidence of skeletal relapse after maxillary advancement in cleft lip and palate (CLP) patients differ with the use of distraction osteogenesis versus conventional osteotomy?
Clinical Bottom Line CLP patients treated with distraction osteogenesis demonstrate greater skeletal stability when compared to those treated with conventional maxillary osteotomy.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 20299247Chua/201022 CLP patients who required maxillary advancement were treated with distraction osteogenesis (DO) and 25 patients were treated with maxillary osteotomy (MO).Randomized controlled trial
Key resultsCLP patients in the DO group underwent a mean maxillary advancement of 7.04mm and a downward movement of 1.31mm when measured from point-A. MO patients had a mean advancement of 6.84mm and a downward change of 1.16mm at surgery. Horizontal and vertical changes were assessed on lateral cephalograms after distraction or surgery for various time points up to 5 years. Horizontal changes after distraction/surgery. At 2-8 weeks, the maxillae of DO patients moved forward from its distracted position a mean of 1.53mm measured from point-A, whereas the maxillae of MO patients moved posteriorly (relapsed) 0.48mm (p=.0001). At 8-12 weeks, the maxillae of DO patients moved forward another 0.76mm, whereas the maxillae of MO patients relapsed 0.32mm (p=.007). At 6-12 months, the maxillae of DO patients moved forward .06mm, whereas the maxillae of MO patients relapsed 0.52mm (p=.002). At 3-4 years, the maxillae of DO patients moved forward 0.28mm, whereas the maxillae of MO patients relapsed 0.16mm. At 5 years after surgery, the maxillae of DO patients moved forward an overall mean of 2.27mm from point-A, whereas the maxillae of MO patients relapsed an overall mean of 2.53mm. The percent relapse of the maxillae were found to be highly significant between the two treatment groups (p<.01) from 8 weeks to 5 years post-surgery. Vertical changes after distraction/surgery. At 2-8 weeks after distraction, the maxillae of DO patients moved downward 1.26mm from its distracted position measured from point-A, whereas the maxillae of MO patients moved upwards 0.16mm (p=.037). At 3-6 months, the maxillae of DO patients moved upwards 0.43mm, whereas that of MO patients had a downward change of 0.13mm (p=.023). At 2-3 years, the maxillae of DO moved downward 0.64mm, whereas MO patients moved upwards 0.21mm (p=.025). At 5 years after surgery, the maxillae of DO patients moved an overall mean of 1.09mm in the downward direction from point-A, whereas the maxillae of MO patients moved upwards (relapsed vertically) 0.4mm. The percent changes in the vertical position of the maxillae at point-A were found to be statistically insignificant between the treatment groups. Significant angular changes between the upper central incisors and the Sella-Nasion line were found between DO patients and MO patients at 1-5 years after surgery (p=.041, .043, .004, .002, .022).
#2) 16980862Cheung/2006CLP patients who required maxillary advancement and treated with either distraction osteogenesis (n=15) or maxillary osteotomy (n=14).Randomized Controlled Trial
Key resultsThe distraction group had a mean advancement of 6.7mm while the osteotomy group had 5.3mm of advancement. At 8-12 weeks after distraction, the maxillae of DO patients measured from point-A were found to have moved forward by an additional 1.7mm while the maxillae of MO patients moved backwards (relapsed) 1.1mm (p=.017). After 3 months, differences between DO and MO patients were found to be insignificant. Nevertheless, the maxillae of DO patients remained advanced 1 year after distraction while MO patients relapsed into a Class III malocclusion.
Evidence Search (((("Maxilla/surgery"[MAJR]) AND "Cleft Palate/surgery"[MAJR]) AND "Osteotomy, Le Fort"[MeSH Terms]) AND "Osteogenesis, Distraction"[MAJR]) AND "Recurrence"[MeSH Terms]
Comments on
The Evidence
Both studies selected CLP patients above the age of 16 with closed radial epiphyseal plates confirmed on radiographs. Individuals with systemic diseases or syndromes were excluded from the study. Patients in need of a 4 to 10mm advancement were randomly assigned to either a maxillary osteotomy group or distraction group (using internal distractors). Lateral cephalometric radiographs were used as measurement tools for postoperative maxillary movement. Microscrews at the point-A were used to quantify horizontal and vertical movements in relation to reference lines. The angle formed between the central axis of the maxillary central incisor and the Sella-Nasion line was used to evaluate angular changes of the maxilla.
Applicability These findings are relevant to CLP patients needing treatment for maxillary advancement and to the surgeons who seek to teat these patients.
Specialty/Discipline (Oral Surgery) (Pediatric Dentistry)
Keywords Maxillary advancement, surgical relapse, maxillary osteotomy, distraction osteogenesis
ID# 2445
Date of submission: 03/05/2013spacer
E-mail hua@livemail.uthscsa.edu
Author Jack Hua
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Edward Ellis III, DDS
Faculty mentor/Co-author e-mail ellise3@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
spacer
Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
post a comment
None available
spacer

Return to Found CATs list