Phd in INNOVATIVE TECHNOLOGIES IN DISEASES OF
SKELETON, SKIN AND ORO-CRANIOFACIAL DISTRICT

Thesis title: 20 ANNI DI ESPERIENZA NELLA DISTRAZIONE OSTEOGENETICA DEL MASCELLARE IN PAZIENTI AFFETTI DA LABIOPALATOSCHISI E PALATOSCHISI: ANALISI DEI DATI E MATURAZIONE DI UN ALGORITMO SPECIFICO DI TRATTAMENTO

In patients with cleft lip and palate, the maxilla is hypoplastic in both the sagittal and vertical planes, with retrusion and posterosuperior rotation, due to congenital factors and scarring secondary to primary surgical repairs. These factors make maxillary correction a critical step in the management of cleft patients. Complications and postoperative instability of traditional surgical treatment have led to the development of alternative methods, including distraction osteogenesis (DO), which allows for gradual and biologically controlled advancement of the maxilla. A retrospective study was conducted including all patients born between 1979 and 2007 with surgically corrected bilateral or unilateral cleft lip or palate, severe maxillary hypoplasia and inter-arch discrepancy greater than 6 mm requiring surgical correction. All patients were followed up and surgically treated in the Department of Plastic and Maxillofacial Surgery at Bambino Gesù Children's Hospital in Rome between 2008 and 2024. A sample of 49 patients was analyzed through clinical, radiological, cephalometric, and statistical analyses. Long-term post-surgical maxillary relapse was studied in detail, correlating it with the timing of surgery and the extent of initial advancement. Statistically significant data were obtained, allowing the relapse rate to be correlated with the patient's skeletal maturity and initial advancement. This information allowed us to revise and refine the treatment algorithm currently used at the Bambino Gesù Children's Hospital. This thesis therefore aims to: 1. Analyze the biological and biomechanical foundations of maxillary distraction osteogenesis; 2. Describe the main surgical techniques used in patients with cleft lip and palate; 3. Evaluate the clinical and functional results in a representative case series; 4. Compare DO with traditional maxillary osteotomy techniques, in light of recent international literature; 5. Discuss future prospects for integrating distraction surgery, digital planning, and additive technologies.