Using Le-Fort I osteotomy orthognathic surgery (OGS) to advance the maxilla may create questionable stability, infection of bone grafting and soft tissue boundary in the great amount of correction. Distraction osteogenesis (DO) can be used as an alternative for maxillary advancement. The purpose of this case is using DO instead of OGS to solve severe maxillary hypoplasia problem.
Cases
A 17Y5M male with cleidocranial dysostosis is regularly followed-up in our craniofacial center. The clinical findings were Class III malocclusion with severe midface retrusion and multiple supernumerary teeth. Original treatment plan was orthodontic treatment combining with OGS for maxillary advancement. After checking the CT before surgery, the bone quality was too poor for surgeon to rigid fix. Hence, we used DO with trans-cutaneous RED to correct severe bony discrepancy. High Le-Fort I osteotomy was performed with the fixation plates being placed on the lower part of pyriform aperture. After 12 days, distraction started at a rate of 1 mm/day. The total amount of maxillary advancement was 15 mm after 6-weeks activating. Within 3 month of maintenance, all the devices were removed. The final overjet and overbite were 2 mm.
Discussion and Summary
Maxillary DO with RED can correct severe midface retrusion, including both skeletal and soft-tissue deficiency. Besides, we placed the fixation plate directly to the maxilla, we can reduce the dental side-effect during protraction. In this case, the treatment outcome is good with DO. The patient is also satisfied with the profile change and continuing orthodontic treatment.