**5. Conclusion**

Consolidation period of 8 to 12 weeks is generally accepted in UCLP patients to prevent the risk of possible skeletal relapse [32, 51, 54, 62]. During consolidation period, bone mineraliza‐ tion of the distraction zone and bone remodelling occur according to the Ilizarov's principles.

The horizontal maxillary advancement usually measured as the advancement of point A ranged from 5.7 to 34 mm [34, 54, 59, 61, 62]. The average increase in SNA angle is between

The vertical changes in point A are between −1.1 mm (meaning counterclockwise rotation of

The counterclockwise rotation of the maxilla can be a result of inconvenient distraction force vector and can be changed by the use of the orthodontic elastic traction that can be applied

**Figure 12.** Intra-oral photographs of a 21-year-old boy affected by severe maxillary hypoplasia due to unilateral cleft lip and palate treated in our clinic before internal distraction and after consolidation period (after using orthodontic

**Figure 13.** Pre-operative and post-operative extra-oral photographs and cephalometric films of the same patient.

the maxilla) to 7 mm (meaning clockwise rotation of the maxilla) [34, 54, 61, 62].

The increase of the overjet ranged from 6.59 to 13.66 mm [51, 61].

*Skeletal changes (horizontal and vertical)*

between upper and lower teeth [1, 4, 34, 42].

5.65 and 10.8 degrees [40, 54].

76 Advanced Techniques in Bone Regeneration

*Dental changes*

elastic traction and removal).

The use of distraction osteogenesis was proved as a predictable method for major bone elongation with the generation of new bone in the distraction site. Newly formed bone can provide good support and thus contribute to stability. Many surgeons and orthodontists prefer sagittal maxillary distraction osteogenesis in maxillary deficiency, especially in patients with cleft lip and palate or in syndromic patients. Virtual surgical planning and/or stereolitho‐ graphic modelling allow more predictable operation and distraction.

Sagittal distraction forces produce not only advancement forces at the intermaxillary sutures but also higher stress values at the sutura nasomaxillaris, sutura frontonasalis and sutura zygomaticomaxillaris on the cleft side of the patients with unilateral cleft lip and palate rather than the non-cleft side. Some patients feel pressure under the eyes, around the lateral nasal walls and generally throughout the face during and after the distractor activations. One should consider the consequences of the activation of the distractors under the light of these findings. Since the clinical effectiveness of the maxillary distraction osteogenesis, especially in patients with cleft lip and palate, is highly dependent on the presence of the scar tissue, it would be helpful to incorporate this soft tissue into future mathematical models.

For patients with mild to severe maxillofacial deficiencies, conventional one-step LeFort I maxillary advancement is out of limits, and advancement using distraction osteogenesis has been shown to be a stable, reliable treatment modality in such cases.

### **Author details**

Sultan Olmez-Gurlen

Address all correspondence to: sultanolmez@gmail.com

Private Practitioner, Izmir, Turkey

### **References**


[11] Rachmiel A, Rozen N, Peled M, Lewinson D Characterization of midface maxillary membranous bone formation during distraction osteogenesis. Plast Reconstr Surg. 2002;109:1611-1620.

**Author details**

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