The Long Term Stability and Histology of Anterior Maxillary Distraction Osteogenesis in Hypo Plastic Maxillae in Cleft Lip and Palate Patients

Abstract

Cleft lip and cleft palate are congenital malformations resulting in non-fusion of lip and palate during development in utero. These clefts of the lip and palate are some of the more commonly occurring malformations observed in 1:800 live births. Apart from the obviously detrimental cosmetic effects, these malformations contribute to feeding difficulties right from birth, persistent recurring ear infections, speech difficulties, dental problems and psychological challenges. newlineThe management of these patients requires a team of specialists with a treatment plan from birth to adulthood directed towards ensuring the child s ability to eat, drink, speak, hear and a normal facial appearance. newlineObjectives: 1) To study the stability of this procedure by : i) Pre and post operative radiographic records; ii) Pre and Post Operative Photographs 2) To study the histology of soft tissues in the distraction zone. 3) To do a pilot assessment of speech before and after distraction surgery. This innovative technique of distraction of a scarred, operated cleft palate by means of segmental distraction has shown to be more stable than the classical methods of Le-Fort 1 distraction. newlineThe technique has no deleterious effects on speech when analyzed by speech language pathologists. This is a significant factor while considering surgical options in patients with pre-existing speech disorder or velo-pharyngeal dysfunction (VPD). Histology shows that there is a hyperplasia of soft tissue in the region of the regenerate and that distraction is possible even in scar tissue. The distracted regenerate bone was of adequate volume and quality to be able to have orthodontic realignment or support an osseo-integrated implant. The complications seen were minor and easily rectifiable. Patient adaptation and acceptance was good. However, patient s attenders have to be alert enough to activate the appliance correctly and note any complication early enough. newline newline