Maxillary distraction in cleft lip palate patients: A review of six cases

Cleft lip and palate patients can present with a maxillary retrusion with t endency to Class III malocclusion after cleft repair. Maxillary distraction osteogenesis is a technique that provides simultaneous skeletal advancemen t and expansion of the soft tissues. Six nonsyndromic cleft lip and palate patients, ages 12 to 16 years (mean, 13.8 years), underwent maxillary distr action; four had a unilateral and two a bilateral cleft lip and palate. Aft er an incomplete LeFort I osteotomy, a latency period of 3 days was respect ed. On Postoperative Day 4, distraction was initiated through anterior trac tion on a Delaire facial mask using distraction forces of 900 gm. Photograp hs and lateral cephalometric radiographs were obtained preoperatively and 4 months after distraction. A cephalometric analysis was performed to compar e the sagittal dentocraniofacial morphology before and after distraction. T he aesthetic improvement obtained by maxillary distraction osteogenesis dur ing the permanent dentition to correct maxillary retrusion in our cleft lip and palate patients was impressive. Skeletal advancement varying from 1 to 3.5 mm (mean, 1.7 mm) was found. However, significant dentoalveolar compen sations occurred in three patients. This was due to the dental anchorage of the distraction device and can be avoided only by the use of skeletal fixa tion.