Bone Lengthening Technique Helps Cleft Palate

A technique called distraction osteogenesis can create increased length of the upper jaw in patients with cleft lip and palate deformities, reports a study in the March issue of The Journal of Craniofacial Surgery.

Emeka Nkenke, M.D., of Erlangen University Hospital in Germany, and colleagues, report on the use of distraction osteogenesis to lengthen the maxilla (upper jaw) bone in patients with cleft lip and palate. In this technique, hardware is placed to gradually “stretch” bone in the desired direction. The researchers studied the bone-lengthening approach because the maxilla often regresses toward its original position after standard surgical advancement techniques.

Distraction osteogenesis was used in seven adolescent to young adult patients with cleft lip and palate deformities and “maxillary hypoplasia” (very small maxilla). The technique successfully increased the length of the maxilla by an average of 6.4 millimeters. During follow-up, the new bone regressed significantly – by about 7.5 percent. However, that was much less than the 50 percent or greater regression that can occur after standard surgical approaches.

Complications included an infection in one patient and loosening of the distraction hardware in another. Nkenke and her coauthors conclude that, when needed to create maxillary bone length of no more than 12 millimeters, the benefits of the distraction osteogenesis technique outweigh the risks.