Maxillary anterior segmental distraction osteogenesis (MASDO) in orthodontic treatment of cleft lip and palate patients.

Takashi Yamashiro, DDS, PhDDepartment of Orthodontics and Dentofacial Orthopedic

Graduate School of Dentistry, Osaka University

TUE MAY 8, Room 207 - Level 2 8:00 AM - 8:30 AM

Patients with a cleft lip and palate typically show a high incidence of Class III malocclusion and mid-facial retrusion. Maxillary anterior segmental distraction osteogenesis (MASDO) facilitates the forward advancement of the anterior maxillary segments without affecting the patient’s velopharyngeal function. The segmental osteotomy also corrects the anteriorly-flattened dental arches and enhance the crown exposure of the upper incisors. Furthermore, MASDO can be applied in combination with transverse distraction osteogenesis or LeFort1 osteotomy. I will demonstrate that MASDO is effective for correcting severe skeletal Class III problems in patients with cleft lip and palate.

IndicationsMASDO is new alternative to LeFort1 osteotomy or employed in combination with LeFort1 and/or TDO for use in CLP patients with severe class III problmes exhibiting

1) VPI.

2) flattened dental arch.

3) limited crown exposure of the upper incisors.

RetentionThe average relapse rate at 1 year after MASDO was less than 20% and the greater relapses were considered to be related to bite-opening rotation of the Mx during the operation.

Post-MASDO Orthod TxThe distracted bone gap can be closed efficiently by orthodontic tooth movement.

Dr. Yamashiro is a professor and chairman of orthodontics at Osaka University, Japan. Prior to his current position, he chaired the orthodontic departments of Okayama University. He received his dental degree, clinical training in orthodontics and doctoral degree on bone biology from Osaka University. He is a member of the Edward H. Angle Society of Orthodontists (East component) and a Fellow of Dental Surgery, Royal College of Surgeon of Edinburgh. His post-doctoral studies were in developmental biology in Helsinki, Finland. His scientific interests include the biological and molecular mechanism of palatogenesis, tooth development and craniofacial development. He is on the Editorial Board of European Journal of Orthodontics, Orthodontics and Craniofacial Research.

Introduction

• Iida S, Yagi T, Yamashiro T. Maxillary anterior segmental distraction osteogenesis with the dynaformsystem for severe maxillary retrusion in cleft lip and palate. Plast Reconstr Surg 2007;120:508-516. PMID: 17632357

• Aikawa T, Haraguchi S, Tanaka S, Uematsu S, Ishibashi M, Kogo M, Iida S. Rotational movement of the anterior maxillary segment by hybrid distractor in patients with cleft lip and palate. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;110(3):292-300. PMID: 20418128

Clinical application and Case Reports

• Tanikawa C, Lee DH, Yamamoto-Oonishi Y, Haraguchi S, Aikawa T, Kogo M, Iida S, Yamashiro T. The elimination of dental crowding and development of a proper dental arch by Maxillary Anterior Segmental Distraction Osteogenesis for a patient with UCLP. Cleft Palate Craniofac J. 2018; in press

• Nakatsugawa K, Kurosaka H, Mihara K, Tanaka S, Aikawa T, Kogo M, Yamashiro T: Orthodontic- surgical approach for treating skeletal Class III malocclusion with severe maxillary deficiency in isolated cleft, Cleft Palate Craniofac J. 2-18; in press

• Yagi T, Yamashiro T, Miyawaki S: Treatment of severe maxillary hypoplasia with oligodontia and complete bilateral cleft lip and palate by maxillary anterior segmental distraction osteogenesis, Orthodontic Waves 2018;77(1)57-65.

• Kageyama-Iwata A*, Haraguchi S, Iida S, Aikawa T, Yamashiro T: Maxillary Anterior Segmental Distraction Osteogenesis to Correct Maxillary Deficiencies in a Patient With Cleft Lip and Palate, Cleft Palate Craniofac J. 2017;54:465-473, PMID: 27115561

• Hirata K, et al. Asymmetric Anterior Distraction for Transversely Distorted Maxilla and MidfacialAnteroposterior Deficiency in a Patient With Cleft Lip/Palate: Two-Stage Surgical Approach. Cleft Palate Craniofac J. 2016;53(4):491-8. PMID: 26237186

• Shintaku Y, Tanikawa C, Iida S, Aikawa T, Kogo M, Yamashiro T. Maxillary Expansion and Midline Correction by Asymmetric Transverse Distraction Osteogenesis in a Patient With Unilateral Cleft Lip/Palate: A Case Report. Cleft Palate Craniofac J. 2015;52(5):618-24. PMID: 25531734

Retention and Stability

• Tanikawa C, Hirata K, Aikawa T, Maeda J, Kogo M, Iida S, Yamashiro T: Efficacy of maxillary anterior segmental distraction osteogenesis in patients with cleft lip and palate, Cleft Palate Craniofac J. 2018;in press PMID: 29533696.

Textbook

• Yamashiro T and Iida S: Class III Treatment for Patients with Cleft Lip and Palate, Orthodontic Treatment of Class III Malocclusion, Ed. Ngan P, Deguchi T and Roberts EW, Bentham Books, 2014, 440-463. DOI: 10.2174/9781608054916114010017

References