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Transpalatal distraction for the management of maxillary constriction in pediatric patients.

Adolphs N, Ernst N, Hoffmeister B, Raguse JD - Ann Maxillofac Surg (2015 Jan-Jun)

Bottom Line: Skeletal conditions were obviously improved for subsequent orthodontic or orthognathic therapy without functional impairment.Follow-up is up to 36 months after device removal.Transpalatal Distraction is recommendable in selected pediatric patients if massive growth disturbance is present or has to be expected.

View Article: PubMed Central - PubMed

Affiliation: Department of Craniomaxillofacial Surgery, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany.

ABSTRACT

Context: The management of severe maxillary constriction can be challenging. For that purpose surgically assisted maxillary expansion by transpalatal distraction (TPD) can typically be recommended after skeletal maturity. However in selected cases bone borne transpalatal distraction devices can contribute to improve maxillary constriction considerably earlier already during mixed dentition.

Aims: To assess the possibility of bone borne transpalatal distraction in pediatric patients.

Settings and design: Clinical paper.

Materials and methods: Since 2010 TPD has been applied to six pediatric patients during mixed dentition when severe maxillary constriction was present and conventional orthodontic widening has already failed. Individually selected devices (Surgitec, Belgium) were inserted in general anaesthesia and distraction was performed according to well known parameters.

Results: Maxillary constriction could be improved in all six patients without any drawbacks by bone borne devices during mixed dentition. Skeletal conditions were obviously improved for subsequent orthodontic or orthognathic therapy without functional impairment. Follow-up is up to 36 months after device removal.

Conclusions: Transpalatal Distraction is recommendable in selected pediatric patients if massive growth disturbance is present or has to be expected. TPD allows for individually adapted maxillary expansion by selection and positioning of appropriate devices in combination with intraoperative testing of maxillary movements and controlled bone removal.

No MeSH data available.


Related in: MedlinePlus

First patient of the series 11-year-old girl affected by dysostotic conditions in the premaxilla-preceding conventional orthodontic widening had failed (a and b) intraoperative situation with activation of the device up to 10 mm interincisal distance (c) clinical situation 4 months later after spontaneous closure of the gap (d) situation before removal of the device and additional extraction of the right upper second premolar
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Figure 3: First patient of the series 11-year-old girl affected by dysostotic conditions in the premaxilla-preceding conventional orthodontic widening had failed (a and b) intraoperative situation with activation of the device up to 10 mm interincisal distance (c) clinical situation 4 months later after spontaneous closure of the gap (d) situation before removal of the device and additional extraction of the right upper second premolar

Mentions: Transpalatal distraction was established in the department in 2007. More than 60 procedures have been performed successfully since that time with or without subsequent orthognathic procedures. In six pediatric patients affected by severe transverse maxillary deficiency TPD has been applied before skeletal maturity. Bone borne surgically assisted maxillary expansion was indicated either after ineffective orthodontic treatment or when maxillary constriction was obvious which could likely not be corrected by orthodontic appliances alone. For surgical planning conventional panorex in order to assess the position of the permanent teeth, plaster casts and intra- and extra-oral photo documentation was used [Figures 1–3]. Selection of appropriate bone borne devices was performed according to the best fit of the device on individual plaster casts. The Surgitec TPD “All-in-one” (Surgitec, 9051-Sint-Denijs-Westrem, Belgium) in different sizes was used in all patients of that series. In all patients, the devices were inserted according to the manufacturer's data[5] under general anesthesia and perioperative i.v. antibiotic treatment. Surgery consisted in a modified subtotal LeFortI osteotomy according to Betts including median maxillary split without pterygomaxillary disjunction.[6] The devices were activated intraoperative in order to control the maxillary movements respectively to correct the position of the devices [Figures 1d and 3c]. In order to allow for maxillary expansion without interference stepwise bony resection at paranasal and zygomaticoalveolar buttresses was performed during activation protecting the permanent teeth. Intraoperative activation was performed in accordance with the required maxillary expansion. Devices were subsequently reset and locked during latency phase. Gradual activation of the devices was started by the same surgical team after a latency phase of 5-7 days. Depending on the individual tissue feedback, gradual distraction was performed with a rate of up to 1 mm/day. After ending of active distraction, devices were locked during the consolidation phase. Length of the resulting interincisival diastema as a parameter for the distraction length was measured by a caliper intraoperative and after ending of activation. Based on experimental data the consolidation period was intended to be at least 3 months.[7] Removal of the devices was scheduled after consolidation time and clinical examination for transverse stability. In all patients photo documentation of the preoperative, intraoperative and postoperative follow-up situations was performed. All distraction related data were recorded in patient-specific distraction protocols. For the retrospective evaluation photo documentation, distraction protocols, dental casts were used. A simple qualitative assessment of the method was performed after device removal: “Would you have TPD again"/"would we recommend TPD again” (±).


Transpalatal distraction for the management of maxillary constriction in pediatric patients.

Adolphs N, Ernst N, Hoffmeister B, Raguse JD - Ann Maxillofac Surg (2015 Jan-Jun)

First patient of the series 11-year-old girl affected by dysostotic conditions in the premaxilla-preceding conventional orthodontic widening had failed (a and b) intraoperative situation with activation of the device up to 10 mm interincisal distance (c) clinical situation 4 months later after spontaneous closure of the gap (d) situation before removal of the device and additional extraction of the right upper second premolar
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4555948&req=5

Figure 3: First patient of the series 11-year-old girl affected by dysostotic conditions in the premaxilla-preceding conventional orthodontic widening had failed (a and b) intraoperative situation with activation of the device up to 10 mm interincisal distance (c) clinical situation 4 months later after spontaneous closure of the gap (d) situation before removal of the device and additional extraction of the right upper second premolar
Mentions: Transpalatal distraction was established in the department in 2007. More than 60 procedures have been performed successfully since that time with or without subsequent orthognathic procedures. In six pediatric patients affected by severe transverse maxillary deficiency TPD has been applied before skeletal maturity. Bone borne surgically assisted maxillary expansion was indicated either after ineffective orthodontic treatment or when maxillary constriction was obvious which could likely not be corrected by orthodontic appliances alone. For surgical planning conventional panorex in order to assess the position of the permanent teeth, plaster casts and intra- and extra-oral photo documentation was used [Figures 1–3]. Selection of appropriate bone borne devices was performed according to the best fit of the device on individual plaster casts. The Surgitec TPD “All-in-one” (Surgitec, 9051-Sint-Denijs-Westrem, Belgium) in different sizes was used in all patients of that series. In all patients, the devices were inserted according to the manufacturer's data[5] under general anesthesia and perioperative i.v. antibiotic treatment. Surgery consisted in a modified subtotal LeFortI osteotomy according to Betts including median maxillary split without pterygomaxillary disjunction.[6] The devices were activated intraoperative in order to control the maxillary movements respectively to correct the position of the devices [Figures 1d and 3c]. In order to allow for maxillary expansion without interference stepwise bony resection at paranasal and zygomaticoalveolar buttresses was performed during activation protecting the permanent teeth. Intraoperative activation was performed in accordance with the required maxillary expansion. Devices were subsequently reset and locked during latency phase. Gradual activation of the devices was started by the same surgical team after a latency phase of 5-7 days. Depending on the individual tissue feedback, gradual distraction was performed with a rate of up to 1 mm/day. After ending of active distraction, devices were locked during the consolidation phase. Length of the resulting interincisival diastema as a parameter for the distraction length was measured by a caliper intraoperative and after ending of activation. Based on experimental data the consolidation period was intended to be at least 3 months.[7] Removal of the devices was scheduled after consolidation time and clinical examination for transverse stability. In all patients photo documentation of the preoperative, intraoperative and postoperative follow-up situations was performed. All distraction related data were recorded in patient-specific distraction protocols. For the retrospective evaluation photo documentation, distraction protocols, dental casts were used. A simple qualitative assessment of the method was performed after device removal: “Would you have TPD again"/"would we recommend TPD again” (±).

Bottom Line: Skeletal conditions were obviously improved for subsequent orthodontic or orthognathic therapy without functional impairment.Follow-up is up to 36 months after device removal.Transpalatal Distraction is recommendable in selected pediatric patients if massive growth disturbance is present or has to be expected.

View Article: PubMed Central - PubMed

Affiliation: Department of Craniomaxillofacial Surgery, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany.

ABSTRACT

Context: The management of severe maxillary constriction can be challenging. For that purpose surgically assisted maxillary expansion by transpalatal distraction (TPD) can typically be recommended after skeletal maturity. However in selected cases bone borne transpalatal distraction devices can contribute to improve maxillary constriction considerably earlier already during mixed dentition.

Aims: To assess the possibility of bone borne transpalatal distraction in pediatric patients.

Settings and design: Clinical paper.

Materials and methods: Since 2010 TPD has been applied to six pediatric patients during mixed dentition when severe maxillary constriction was present and conventional orthodontic widening has already failed. Individually selected devices (Surgitec, Belgium) were inserted in general anaesthesia and distraction was performed according to well known parameters.

Results: Maxillary constriction could be improved in all six patients without any drawbacks by bone borne devices during mixed dentition. Skeletal conditions were obviously improved for subsequent orthodontic or orthognathic therapy without functional impairment. Follow-up is up to 36 months after device removal.

Conclusions: Transpalatal Distraction is recommendable in selected pediatric patients if massive growth disturbance is present or has to be expected. TPD allows for individually adapted maxillary expansion by selection and positioning of appropriate devices in combination with intraoperative testing of maxillary movements and controlled bone removal.

No MeSH data available.


Related in: MedlinePlus