Efficacy of modified anterior maxillary segmental distraction osteogenesis based on 3D visualisation for the treatment of maxillary hypoplasia among adolescents with cleft lip and palate

Abstract

Background: This study evaluates a three-dimensional (3D) visualisation design combined with customized surgical guides to assist anterior maxillary segmental distraction osteogenesis (AMSDO) in correcting maxillary hypoplasia in adolescents with cleft lip and palate (CLP), focusing on treatment outcomes, satisfaction and the validity of 3D planning.

Methods: This retrospective cohort study was conducted at a single hospital in China. Between January 2020 and December 2023, 12 adolescents with CLP with maxillary hypoplasia were included. An advanced 3D simulation was used to convey the treatment strategy to the patients and their families. A customized surgical guide and distraction osteogenesis device were designed. Cephalometric analysis evaluated AMSDO changes and long-term stability. Patient satisfaction was assessed. The Chinese version of the Child Oral Health Impact Profile was used to evaluate the children's oral health-related quality of life before and after treatment. The postoperative outcomes were compared with the planned outcomes by superimposing the actual postoperative data onto the simulated soft tissue models and calculating the linear and angular differences between them.

Results: One patient experienced postoperative gingivitis, yielding an 8.33% complication rate. Most patients (83.33%) were highly satisfied with the target position, with the rest content. Cephalometric analysis showed significant improvements in various indices post-traction. Quality-of-life scores significantly improved post-treatment. The discrepancies in facial soft tissue between the simulated and actual results were within clinically satisfactory ranges.

Conclusions: Digitally designed surgical guides effectively treat maxillary hypoplasia in adolescents with CLP, ensuring stability, reducing complications, reducing dependency on operator experience, and enhancing satisfaction and health outcomes. Although the simulated results were clinically acceptable, it is important to inform patients of potential variations in the predicted soft tissue.

Keywords: Anterior maxillary segmental distraction osteogenesis (AMSDO); Child oral health impact profile (COHIP); Cleft lip and palate (CLP); Customized 3D-printed surgical splints; Maxillary hypoplasia.

Fig. 1

Planning surgical pathways for different cross-sections a Relationship between the right maxillary osteotomy line and the teeth (cross-sectional view) b Relationship between the right maxillary osteotomy line and the teeth (sagittal view). c Relationship between the left maxillary osteotomy line and the teeth (3D elevation view). d Relationship between the left maxillary osteotomy line and the teeth (3D front view). e Tooth-bone segment after simulated osteotomy (3D elevation view)

Fig. 2

Surgical guide plate. a Software simulation of customized modified guides. b Customized modified guide plates (small). c Software simulation of conventional guides. d Conventional guide plate (large). e Intraoperative use of guide plates. f Intraoperative osteotomy line

Fig. 3

Customised tooth-borne distractor (expander in the posterior region can be replaced by a transpalatal arch)

Fig. 4

Comparison of various factors and total scores of the COHIP scale before and after treatment. COHIP, Child Oral Health Impact Profile

Fig. 5

Comparison of surgical simulation and actual face profile. a Facial simulation before treatment. b Facial simulation at the target position. c Actual facial profile before treatment. d Actual facial profile at the target position

Fig. 6

Profile and intraoral occlusion of the patient before AMSDO, reaching the target position as planned and 1 year after AMSDO treatment. a Photographs, intraoral view and lateral cephalometric radiograph before AMSDO. b Photographs, intraoral view and lateral cephalometric radiograph when the target position was reached as planned. c Photographs, intraoral view and lateral cephalometric radiograph 1 year after AMSDO treatment

Fig. 7

Overlap of the ‘simulated’ and ‘1-year post-operative’ 3D models. The bar on the left side indicates the differences between the two models. The areas with purple colouration exceeded the 2-mm threshold (areas of inaccuracies). a, d, g Facial simulation at the target position. b, e, h Actual outcome 1 year post-operation. c, f, i Overlap of the ‘stimulated’ and ‘1-year post-operative’ 3D models