Maxillary distraction complications in cleft patients J. Ferri

Rev Stomatol Chir Maxillofacial 2008: 19: 218-223 The author presented the applications of maxillary distraction osteogenesis (DO) to children and possible side effects of early surgery on maxillary growth. The author questioned the validity of performing early DO in children. Publications were discussed, particularly about the work of Sarnat (1966) on the growth of the face and jaws after resection of the septal cartilage; Topazian & Korkich-Schapiro (1982) on Lefort I and cranio-facial growth in young animals. The author concluded to warn against early Lefort I with the potential risk of interfering with growth. However, some of the key literature were missing:

• –

  The experimental result of septum resection [Moss et al. (1968), Freng (1968); Babula et al. (1970), Thilander (1970)] showing the absence of side effects on the sagittal growth.

• –

  Septum resection in young chimpanzees without side effects on growth (Siegel)

• –

  Clinical septoplasty cases in young children (Ortiz Monasterio) that did not create growth deficiency.

• –

  Lefort III osteotomy and early facial bipartition with septum ethmoid bone excision are compatible with satisfactory growth (Tessier-Tulam 1982)

The contradictory results that were described in animal studies where the growth could be different and this can lead us to view with circumspection relating to the clinical cases. Interceptive surgery still plays a valuable role as mentioned by the author in the early treatment of severe cases especially in syndromic patients associated with functional problems, which will have impact on facial growth and psychological consequences.

PATRICK DINER