21 2 15 25 2006 RED CT 6 15 15 RED 409-3898 1110 2006 7 21 2006 7 21 RED rigid, external, distraction Polley Figueroa 1,2 1 1999 3 RED RED
16 RED Martin halo traction hook 1 halo 9 6 A halo 1 RED a halo b c d traction hook high Le Fort 2 B halo 4 scalp screw halo C 5 4 D 1 2 4 rod 1 0.5 mm1 1 mm 1 1 mm 1 2 1 10 0.24 4 RED 4 3 halo
17 2 high Le Fort a: b: c: d: halo 4 halo scalp screw 2 3 4 1 alopecia halo 3 6 3 A CT 3 halo 6 1 B CT 4 halo 5 8 5A X A ANS [anterior nasal spine ] 6 6 6
18 3 CT A B 2 C 6 4 3D-CT A B 2 C 6 D 1
19 5 A N: nasion ANS: anterior nasal spine U1: upper incisors, L1: lower incisors, Pog: pogonion X X Y Y B N: nasion ANS: anterior nasal spine PNS: posterior nasal spine Uv: uvula PPW: posterior pharyngeal wall X X Y Y 20 6 6 CT B Pog pogonion 7 6 12 12 6 Pog 1 ANS C U1 upper incisors L1 lower incisors U1 ANS L1 Pog L1 U1 D OJ overjet OB overbite 8 OJ OB
20 6 ANS X-axis:X Y-axis Y Pre: halo removal: halo [ 2 ] 3M 3 6M 6 12M 1 24M 2 36M 3 6 6 9 [ ] 60 80 60 7 4 2 1 8 5B A 1 posterior nasal spine PNS PNS PPW posterior pharyn-
21 7 Pog X-axis:X Y-axis Y Pre: halo removal: halo [ 2 ] 3M 3 6M 6 12M 1 24M 2 36M 3 geal wall need ratio B 2 A 1 15 mm 15 mm RED A 1 2 3 B
22 8 OJ overjetob overbite Pre: halo removal: halo 2 3M 3 6M 6 12M 1 24M 2 36M 3 1 2 3 alopecia A CT 6 B. 15 mm
23 1 PPW-PNS PNS-Uv need ratio mm mm PPW-PNS/PNS-Uv 13.0 7.4 14.6 8.3 12.0 15.0 24.2 31.4 0.77 32.2 34.5 0.93 24.5 27.0 0.91 32.0 33.5 0.96 17.5 28.0 0.63 31.5 32.8 0.96 22.3 32.0 0.70 30.2 41.8 0.72 26.3 36.5 0.72 35.2 38.1 0.92 29.1 24.2 1.20 41.2 24.0 1.72 ANS anterior nasal spine PNS posterior nasal spine Uv uvula PPW posterior pharyngeal wall 2 mm 13.0 7.4 14.6 8.3 12.0 15.0 15 mm BMP: bone morphogenetic protein 9,10
24 catch up catch up 15 mm 15 mm 11 15 mm 1 Polley JW, Figueroa AA: Management of severe maxillary deficiency in childhood and adolescence through distraction osteogenesis with an external, adjustable, rigid distraction device. J Craniofac Surg 8: 181 185, 1997. 2 Polley JW, Figueroa AA: Rigid external distraction: Its application in cleft maxillary deformities. Plast Reconstr Surg 102: 1360 1372, 1998. 3 Harada K, Baba Y, Ohyama K, Enomoto S: Maxillary distraction osteogenesis for cleft lip and palate children using an external, adjustable, rigid distraction device: A report of 2 cases. J Oral Maxillofac Surg 59: 1492 6, 2001. 4 Harada K, Sato M, Omura K: Maxillary distraction in patients with cleft deformity using a rigid external distraction device: A pilot study on the distraction ratio of the maxilla to the device. Scand J Plast Reconstr Surg Hand Surg 38(5): 277 280, 2004. 5 Harada K, Sato M, Omura K: Long-term maxillomandibular skeletal and dental changes in children with cleft lip and palate after maxillary distraction. Oral Surg Oral Med Oral Pathol 2006 (in press). 6 Harada K, Baba Y, Ohyama K, Omura K: Soft tissue profile changes of the midface in patients with cleft lip and palate following maxillary distraction osteogenesis: A preliminary study. Oral Surg Oral Med Oral Pathol 94: 673 677, 2002. 7 Harada K, Ishii Y, Ishii M, Imaizumi F, Mibu M, Omura K: Effect of maxillary distraction osteogenesis on velopharyngeal function: A pilot study. Oral Surgery Oral Medicine Oral Pathology 93: 538 543, 2002. 8 Subtelny JD: A cephalometric study of the growth of the soft palate. Plast Reconstr Surg 19: 49 62, 1957. 9 Yonezawa H, Harada K, Yamashita Y, Enomoto S: Effect of recombinant human bone morphogenetic protein-2 (rhbmp-2) on distraction osteogenesis: An experimental study in rabbit mandible. Asian J Oral and Maxillofac Surg 13(1): 1 10, 2001. 10 Yonezawa H, Harada K, Ikebe T, Shinohara M, Enomoto S: Effect of recombinant human bone morphogenetic protein-2 (rhbmp-2) on distraction osteogenesis: A preliminary study in rabbit mandible. J Cranio-Maxillofac Surg 34: 270 276, 2006.
25 11 Ko EW, Figueroa AA, Guyette TW, Polley JW, Law WR: Velopharyngeal changes after maxillary advancement in cleft patients with distraction osteogenesis using a rigid external distraction device: A 1-year cephalometric follow-up. J Craniofac Surg 10: 312 20, 1999.