Survey of Practice Patterns of Maxillary Distraction Osteogenesis Among Craniofacial Surgeons in Patients With Cleft Lip and Palate

Objective We assess current practices in treatment of maxillary hypoplasia in patients with cleft lip and palate regarding LeFort I osteotomy (LFO) and maxillary distraction osteogenesis (DO). Design A 27-question survey was distributed to surgeons in the United States via email addresses obtained through the American Cleft Palate Craniofacial Association (ACPA) website, the ACPA online forum, and a surgeons group on WhatsApp. Setting Responses were recorded in the REDCap platform. Patients and Participants Surgeons treating these patients in the United States were included. Surgeons outside the United States, residents, students, and those not caring for these patients were excluded. Interventions There were no interventions due to the nature of this study. Main Outcome Measures Questions assessed specialty and experience of respondents, treatment considerations guiding practices (risks of treatment, technique, timing, pre- and post-operative assessment). Results Fifty-three surgeons responded to the survey. Sixty-six percent would consider DO for severe maxillomandibular discrepancy, 51% for LFO. Relapse (30%), inability to adequately mobilize (47%) are concerns for LFO; vector control (34%), compliance (18.9%) for DO. At ages 16 to 20 81.1% would consider both, whereas age ages 11 to 15 49.1% would consider DO. Lag phase of <7 days (98.1%), activation at 0.6 to 1 mm/day (71.7%), consolidation of at least 10 weeks (66%) are preferred. Conclusions Surgeons prefer DO for large maxillomandibular discrepancy and scarring from previous surgeries, note less concern for maxillary relapse with DO, but have concern for controlling vector. Surgeons prefer lag phase of <7 days, activation at 0.6 to 1 mm/day, and consolidation of ≥10 weeks.