MAXILLARY DISTRACTION - AESTHETIC AND FUNCTIONAL BENEFITS IN CLEFT LIP-PALATE AND PROGNATHIC PATIENTS DURING MIXED DENTITION

In the last few years, distraction techniques have been used successfu lly to correct the hypoplastic human mandible. In patients with cleft lip and palate, normal growth of the maxilla may be impaired by early cleft repair, and many of them do not respond to orthodontic procedure s alone. Maxillary distraction is an alternative technique to correct maxillary hypoplasia during mixed dentition. In the last 3 years, the procedure was performed in 38 patients aged between 6 and 12 years; 18 patients had unilateral cleft lip and palate, 9 patients had bilatera l cleft lip and palate, 7 patients had unilateral cleft palate, 2 pati ents had prognathism, and 2 patients had nasomaxillary dysplasia. Phot ographs, posteroanterior and lateral cephalograms, and dental models a re obtained preoperatively (as well as an orthopantomogram) to locate the tooth buds. A subperiosteal dissection is performed exposing the a nterior and lateral aspects of the maxilla, and an incomplete horizont al osteotomy is done above the tooth buds. Using a facial mask and an intraoral fixed appliance system as an anchorage, we initiate on the f ifth postoperative day the application of distraction forces. Maxillar y advancement between 4 and 12 mm is achieved during 3 to 4 weeks, and a satisfactory class I or II molar relationship is also obtained. A c ombination of forward and downward distraction forces can be used to a chieve simultaneous advancement and elongation of the hypoplasic maxil la. The aesthetic results are excellent, and the nasolabial angle is i ncreased, including a more anterior projection of the upper lip. Nasal breathing is improved as well as the air flow and patency of the nasa l airway. Velopharyngeal function remains unchanged after the procedur e. The follow-up in this series varied from 6 months to 3 years. No re lapses have been observed.