Midfacial distraction osteogenesis in patients with cleft lip and palate using a segmental osteotomy

The aim of this study was to keep velopharyngeal function and speech intelligibility by using a classical segmental maxillary osteotomy described by ZISSER followed by a distraction osteogencsis in patients with cleft lip and palate and a midfacial hypoplasia. 12 consecutively treated patients with operated unilateral cleft lip and palate were operated using either a segmental osteotomy according to ZISSER (n = 5) or a Le Fort-I osteotomy (n = 7) followed by a distraction osteogenesis in both groups. All patients were examined and analysed by an orthodontist and a speech therapist, who accompanied the whole treatment and also performed the final assessment. The results were stable after a consolidation period of 3 months for all patients. Although three patients already underwent a velopharyngoplasty for improvement of speech no deterioration of speech intelligibility could be assessed in the segmental group, but there was an increase of hypernasality in three patients in the LeFort I group. Both groups developed an improvement of articulation. The technique of segmental osteotomy in the maxilla and distraction osteogenesis for midfacial advancement seems to minimize the risk of velopharyngeal insufficiency.