Surgically-assisted orthopedic protraction of the maxilla in cleft lip and palate patients.

Fourteen children, aged 8 to 13 years, with unilateral or bilateral cleft lip and palate, were treated by an incomplete Le Fort I osteotomy without down-fracturing the maxilla, followed by traction of the maxilla by face mask for twelve weeks. Our results revealed a mean maxillary forward movement of 7.2 mm after three weeks of traction, followed by a retention period of nine weeks for callus maturation. There was an associated minor downward movement of the maxilla that caused a slight increase in the lower facial height, which improved the facial esthetics of the patients. The advantages of this method are: i) it allows for early skeletal advancement of the maxilla with new bone formation in the osteotomy line, ii) there is no need for inter-maxillary fixation of young patients and no need for rigid fixation of the maxilla by miniplates that can damage teeth buds and roots at this age, and iii) it can be used in young patients to improve esthetic appearance, an important factor in the psychological development of adolescents.