AWARENESS OF ANTERIOR MAXILLARY DISTRACTION IN PATIENTS WITH CLEFT LIP AND PALATE IN SOUTH INDIAN POPULATION

Purpose: Distraction Osteogenesis (DO) techniques have become increasingly popular in the craniofacial region and large numbers of studies have reported successful advancement of jaw bones with extra oral distraction devices. However due to problems like discomfort with head frame and social problems associated with extra oral distraction, a better alternative would be internal and intraoral devices. Here, we present cases treated with tooth borne palatal distracter along with its orthodontic management, its efficiency in treating mass patients with cleft lip and cleft palate(CACP) in south Indian population. 

Method(s): Patients under age group 18 to 22 years with Maxillary hypoplasia secondary to cleft lip and palate were chosen for the study.Preoperative profile photographs, orthopantomograph and lateral cephalogram and study models were taken. Surgical technique- Osteotomy cut was made above the apices of the maxillary teeth from the pyriform rim to the predetermined distraction site.  Prefabricated modified Hyrax appliance is then fitted into the maxilla. Modified hyrax orthodontic appliance is a tooth borne custom made appliance that produces anterior movement of maxilla. Post distraction radiographs and photographs are taken.Cephalometric analysis done. Comparitive study – was done to check the efficiency of AMD over conventional Le Fort I osteotomy for treating maxillary hyoplasia. 

Result(s): There was marked changes in the facial profile with positive overjet relationship in the patient after distraction osteogenesis. Statistical analysis was done using SPSS software. In compliance with the paired T test revealed that amount of relapse rate was very much less in patients treated with AMD than conventional Le Fort I osteotomy

Conclusion(s):

Tooth borne distractors are effective alternative technique for treating patients with cleft in order to improve the skeletal dysplasia. Based on statistical study the amount of distraction pertaining to clinical evaluation is significantly greater than those pertaining to cephalomatric analysis and found to be very effective over conventional Le Fort I osteotomy for treating maxillary hypoplasia in patient with CACP. This modified technique is highly feasible, patient friendly, economical and would be of great help for patients belonging to low socio-economic status.