The Surgical and Distraction stage
The surgery was done under local anesthesia. The flaps were horizontal in the mucogingival junction; first, the surgeon removed the right screw and the failure bone graft, and then, he performed the vertical cuts between the first molars and the second premolars and the horizontal cuts above the apices of teeth by using Piezo surgery. The cuts were extended from the buccal cortical bone to the palatal cortical bone, and the surgeon connected the vertical lines to the horizontal lines to mobilize the segment of the premolars and their bones in the two sides. The authors suggested the piezo surgery to avoid the potential roots injury, the palatal tissues and periosteum injuries, and to facilitate the procedure.…show more content… DISSCUSION
In this case, the main reasons to choose the distraction osteogenesis are the failure of the bone grafting and the psychological situation of the patient, so everyone knows how those patients are miserable and have a complicated life because of their face deformities, but this patient has a more complex situation and a hopeless aspiration because he had a failure grafts with scary tissues in the cleft space, and previous seven surgical operations. So the DO is effective solution after BG failure.
Distraction Osteogenesis (DO) creates not only a new immature bone but also new soft tissues with their blood vessels and circulation; on the other hand, the grafts need enough soft tissues to cover the grafting site and to ensure the grafting success.8 The bone grafting has complications; wound dehiscence, partial loss of small bone fragments, external resorption of dental roots, implant high failure rate, and instability of the premaxilla. 9,…show more content… This technique reduces the risks and decrease the bleeding; moreover the pizosurgery can avoid the palatal soft tissues injuries and the other adjacent tissues, and provide a clear vision surgical area.14, 15, 16 all of above is very important to DO.
In the cleft patients with hypoplastic maxilla, the advancement of the maxilla fulfills a well-balanced and harmonized face; either the orthognathic surgery or the distraction osteogenesis achieves a similar advancement of the maxilla. The distraction osteogenesis has a greater facial soft tissue changes, and significantly less horizontal maxillary relapse in compare with the conventional orthognathic surgery.17, 18
In cleft patients with a high rate of grafting failure, we can achieve an ideal results by ArchWise Distraction Osteogenesis. However, the pizosurgery method is very convenient for Do to ensure the palatal soft tissues and other tissues