Distraction Osteogenesis versus Conventional Orthognathic Surgery for Cleft Lip and Palate Management: a Critical Review

In this study the literature dealing with various aspects of two different surgical treatment modalities i.e. distraction osteogenesis and conventional orthognathic surgery were reviewed. The keywords used were distraction osteogenesis; conventional orthognathic surgery; cleft lip and palate; velopharyngeal insufficiency; speech; stability; relapse; complications; quality of life. Apart from these other literature was hand searched. This search revealed a total of 112 articles which included 17 reviews of literature, 4 systematic reviews, 5 randomized controlled trials (RCTs) and 2 meta-analyses. All the literature included in this review was thoroughly reviewed. This review revealed that maxillary distraction in moderate or severe cases of maxillary retrusion offer long-term stability of hard and soft tissues as compared to conventional orthognathic surgery. Cleft lip–cleft palate patients, with severe maxillary deficiency who underwent distraction, had less relapse than those who underwent conventional Le Fort I osteotomy. For mild to moderate cases none of the two procedures i.e. distraction osteogenesis and conventional orthognathic surgery were found to be superior to each other. This literature review has tried to answer a few critical questions regarding all the pros and cons of these two procedures and their future outcomes.