Our Summary

This paper outlines various treatments for “midface hypoplasia” (underdevelopment of the middle part of the face) in patients who were born with a cleft lip or palate. 42 patients who previously had surgeries to correct their cleft lip/palate were studied. The main goal was to improve the functionality and appearance of the face while reducing the chances of the problem returning or causing additional issues.

The researchers used two main types of surgeries: Orthognathic surgery (OS), a type of jaw surgery, and maxillary distraction osteogenesis, a procedure that gradually moves the upper jaw forward. Different techniques within these surgeries were used depending on the specific needs of each patient.

The study showed that the average amount of forward movement in the upper jaw varied based on the surgical technique used. For example, OS resulted in an average forward movement of about 5.58 mm, while other techniques resulted in larger advancements.

The type of surgery chosen depended on the patient’s specific condition. For example, if the patient had underdevelopment around the eye socket or cheekbone, a specific technique was used which required stability in the way the teeth fit together. If the upper jaw was short or teeth were missing, other techniques were used.

The results were generally positive, with only minor incidences of the problem reoccurring or causing changes in speech. The researchers concluded that OS could be used for smaller advancements, while distraction osteogenesis could be used for larger advancements, depending on other factors like teeth alignment and function of the throat.

FAQs

  1. What criteria were proposed for choosing the treatment modality for the management of midface hypoplasia in cleft lip/palate patients?
  2. What were the findings on the average of maxillary advancement for orthognathic surgery, segmental distraction osteogenesis, alveolar transport disc, and midface total distraction osteogenesis?
  3. When is orthognathic surgery indicated and when is distraction osteogenesis indicated in the treatment of cleft lip/palate patients?

Doctor’s Tip

A doctor may advise a patient undergoing cleft palate surgery to follow post-operative care instructions carefully, including proper wound care and dietary restrictions. It is important to attend all follow-up appointments to monitor healing and address any concerns. Additionally, speech therapy may be recommended to help improve speech outcomes post-surgery.

Suitable For

Patients with nonsyndromic cleft lip/palate who have undergone previous primary lip/palate surgeries and do not have previous osteotomies are typically recommended for cleft palate surgery. The decision to undergo orthognathic surgery or maxillary distraction osteogenesis is based on skeletal and dentoalveolar/occlusal criteria, with the goal of improving function, aesthetics, and minimizing the risk of recurrence and secondary alterations. Orthognathic surgery may be indicated for advancements ≤7 mm without the need for orbito-zygomatic advancement, while distraction osteogenesis may be recommended for advances >8 mm with or without the need for orbito-zygomatic advancement, taking into account other dentoalveolar factors and velopharyngeal function.

Timeline

  • Before surgery: The patient undergoes a series of primary lip/palate surgeries to correct the cleft lip and palate. They may also undergo orthodontic treatment to prepare for the surgical correction of midface hypoplasia. The patient is evaluated for the best treatment modality based on functional improvement, aesthetics, and minimizing the risk of recurrence and secondary alterations.

  • During surgery: The patient undergoes either orthognathic surgery or maxillary distraction osteogenesis with anterior segmental osteotomies, alveolar transport disc, or midface total distraction osteogenesis by modified Le Fort III osteotomy. The amount of maxillary advancement varies depending on the chosen treatment modality.

  • After surgery: The patient may experience changes in speech, with 2 patients in the orthognathic surgery group showing detectable changes. However, overall, there was only 1 mm of recurrence in 1 patient in each group. Orthognathic surgery is indicated for advancements ≤7 mm without requiring orbito-zygomatic advancement, while distraction osteogenesis is indicated for advances >8 mm with or without the need for orbito-zygomatic advancement, in addition to other dentoalveolar factors and velopharyngeal function. The patient may also require post-operative orthodontic treatment to achieve optimal results.

What to Ask Your Doctor

  1. What are the different treatment options for cleft palate surgery in my case?
  2. What are the potential risks and complications associated with each type of surgery?
  3. How long is the recovery period for each type of surgery?
  4. Will I need any additional procedures or treatments after the initial surgery?
  5. How will the surgery impact my speech and ability to eat and drink?
  6. Will there be any visible scarring or changes to my facial appearance after the surgery?
  7. How often will I need follow-up appointments after the surgery?
  8. What are the long-term outcomes and success rates of the different surgical options for cleft palate repair?
  9. How experienced is the surgical team in performing cleft palate surgeries?
  10. Are there any lifestyle changes or precautions I need to take before or after the surgery?

Reference

Authors: Fariña R, Lolas J, Moreno E, Alister JP, Uribe MF, Pantoja R, Valladares S, Arrué C. Journal: J Craniofac Surg. 2022 Mar-Apr 01;33(2):496-501. doi: 10.1097/SCS.0000000000007973. PMID: 34261964