Effect of Bone-Borne Trans-Sutural Distraction Osteogenesis Therapy on the Cranial Base of Children With Midfacial Hypoplasia Due to Cleft Lip and Palate

Abstract

Bone-borne trans-sutural distraction osteogenesis (TSDO) is widely used to treat midfacial hypoplasia in children with cleft lip and palate; however, its effects on the cranial base are still poorly understood. The authors aimed to study morphological changes in the cranial base after TSDO. Pre and postoperative computed tomography (CT) images of cleft lip and palate children with midfacial skeleton dysplasia who underwent TSDO were collected retrospectively, and their corresponding 3-dimensional models were measured. Results showed no significant change in the length of the anterior or posterior cranial fossa, but the length of the middle cranial fossa increased significantly. The anterior cranial base rotated upward with the sella turcica at the center, whereas the cranial base angle increased. The sphenoid bone exhibited morphological changes. Post-TSDO, the lateral plate of the pterygoid process increased in length. The angle of the 2 lateral plates of the pterygoid process, the greater wings of the sphenoid bone, and the smaller wings of the sphenoid bone decreased. Posterior inclination of the pterygoid process increased. Mean volume of the sphenoidal sinus increased postoperatively compared with the preoperative volume. Apparent changes in the cranial base after TSDO are primarily in the middle cranial fossa, manifesting as an increase in the sphenoid bone body length, expansion of the sphenoidal sinus volume, growth of the pterygoid process forward and downward, a decrease in the angle of both the greater and smaller wings of the sphenoid bone, and an increase in the posterior inclination of the pterygoid process.