Maxillary advancement in cleft palate patients with intraoral distraction

Introduction

Patients with cleft lip and palate usually present with maxillary hypoplasia. Upper jaw intraoral distraction osteogenesis (DO) is an alternative technique for patients with severe maxillary hypoplasia. An evaluation was made of the changes produced in hard and soft tissues and their stability over time.

Material and methods

Six patients (5 female and 1 male) between 16 and 25 years old with cleft lip and palate underwent maxillary DO with an internal distractor. An evaluation was made of the skeletal and soft tissues changes using cephalometric studies with radiographs and photographs. Follow-up time was between 2 and 8 years.

Results

There was Point A advancement between 3 and 10 mm in 5 patients, significantly improving maxillomandibular relationships. Intraoral DO failed in one patient, and the case was finished using rigid external distraction (RED). In another patient hardly any advancement and maxillary rotation was observed. The relapse observed between 6 and 9 months post DO was between 10 and 15% in both skeletal and soft tissues.

Conclusions

Intraoral DO is a successful alternative technique in maxillary advancement in patients with cleft lip and palate who need an advancement less than 10 mm. It produces improvements in the skeletal and soft profile. Internal devices do not have any psychological impact and have longer consolidation phases. Relapse is difficult to determine and calculate.