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. 2011 May;81(3):410-9.
doi: 10.2319/070110-369.1. Epub 2011 Feb 7.

Determining the osteotomy pattern in surgically assisted rapid maxillary expansion in a unilateral palatal cleft: a finite element model approach

Pawan Gautam  1 , Linping Zhao, Pravin Patel
Affiliations

Determining the osteotomy pattern in surgically assisted rapid maxillary expansion in a unilateral palatal cleft: a finite element model approach

Pawan Gautam et al. Angle Orthod. 2011 May.

Abstract

Objectives: To evaluate the stress pattern in the craniofacial skeleton in a patient with unilateral cleft deformity of the secondary palate and alveolus in response to various techniques of surgically assisted rapid maxillary expansion (SARME).

Materials and methods: Three patient-specific composite skull models were developed for finite element model analysis. The details of the modeling procedure have been described in Part I of this series. The finite element analysis was performed on each model with a specified SARME technique in combination with RME using Abaqus (6.7).

Results: The ideal form of surgery in SARME for patients with unilateral cleft deformity of the secondary palate and alveolus would be complete unilateral LeFort I with pterygoid dysjunction in combination with midpalatal split, followed by isolated midpalatal split and zygomatic buttress osteotomies.

Conclusions: A more invasive SARME technique can significantly reduce the resultant stresses. However, this benefit should be weighed against the risk of increasing complications associated with more extensive surgeries. When a more conservative surgical technique is selected, it would be preferable to perform a midpalatal split rather than zygomatic buttress osteotomies, as indicated by the stress-strain distribution and displacement pattern associated with different SARME techniques.

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Figures

Figure 1
Figure 1
The modeling procedure.
Figure 2
Figure 2
(A) Pattern of overall displacement with zygomatic buttress osteotomy with pterygo-maxillary dysjunction: frontal view. (B) Pattern of lateral displacement (X axis) with zygomatic buttress osteotomy with pterygo-maxillary dysjunction: base of the skull view.
Figure 3
Figure 3
Pattern of Von Mises stress zygomatic buttress osteotomy with pterygo-maxillary dysjunction. (A) Frontal view; (B) Base of the skull view.
Figure 4
Figure 4
(A) Pattern of overall displacement with midpalatal suture split (MPS): frontal view. (B) Pattern of lateral displacement (X axis) with MPS: base of the skull view.
Figure 5
Figure 5
Pattern of Von Mises stress with midpalatal suture split (MPS). (A) Frontal view; (B) Base of the skull view.
Figure 6
Figure 6
(A) Pattern of overall displacement with LeFort I osteotomy with pterygo-maxillary dysjunction in combination with midpalatal split (LeFort I/MPS): frontal view. (B) Pattern of lateral displacement (X axis) with LeFort I/MPS: base of the skull view.
Figure 7
Figure 7
Pattern of Von Mises stress LeFort I osteotomy with pterygo-maxillary dysjunction in combination with midpalatal split (LeFort I/MPS). (A) Frontal view; (B) Base of the skull view.
See this image and copyright information in PMC

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