Simultaneous Maxillary Distraction Osteogenesis Using a Twin-Track Distraction Device Combined with Alveolar Bone Grafting in Cleft Patients: Preliminary Report of a Technique

The simultaneous use of cleft reduction and maxillary advancement by distraction osteogenesis has not been applied routinely because of the difficulty in three-dimensional control and stabilization of the transported segments. This report describes a new approach of simulta- neous bilateral alveolar cleft reduction and maxillary advancement by distraction osteogenesis combined with autogenous bone grafting. A custom-made Twin-Track device was used to allow bilateral alveolar cleft closure combined with simultaneous maxillary advancement, using distrac- tion osteogenesis and a rigid external distraction system in a bilateral cleft lip and palate patient. After a maxillary Le Fort I osteotomy, autogenous iliac bone graft was placed in the cleft spaces before suturing. A latency period of six days was observed before activation. The rate of activation was one mm/d for the maxillary advancement and 0.5 mm/d for the segmental transport. Accord- ingly, the concave facial appearance was improved with acceptable occlusion, and complete bi- lateral cleft closure was attained. No adjustments were necessary to the vector of the transported segments during the activation and no complications were observed. The proposed Twin-Track device, based on the concept of track-guided bone transport, permitted three-dimensional control over the distraction processes allowing simultaneous cleft closure, maxillary distraction, and au- togenous bone grafting. The combined simultaneous approach is extremely advantageous in cor- recting severe deformities, reducing the number of surgical interventions and, consequently, the total treatment time. (Angle Orthod 2006;76:164-172.)