Maxillary distraction osteogenesis: a method with skeletal anchorage.

Maxillary distraction osteogenesis is a challenging technique to treat severe maxillary retrusion. Maxillary advancement by distraction has the advantage to provide new bone in combination with simultaneous expansion of the soft-tissue functional matrix. Cleft lip and palate patients can present with severe maxillary retrusion and Class III malocclusion. Two 13-year-old patients, born with non-syndromic cleft lip and palate, underwent maxillary distraction--one had a bilateral, the other a unilateral complete cleft lip and palate. Maxillary advancement was performed using an external distraction device in combination with titanium miniplates as a skeletal maxillary anchorage. After a complete Lefort I osteotomy with pterygomaxillary disjunction, a latency period of 3 days was respected. On the fourth postoperative day, distraction was initiated at the rate of 1 mm/d. Preoperative clinical photographs, dental casts, lateral cephalograms, and panoramic radiographs were taken. Further lateral cephalograms were obtained after the latency period, after completion of the active period of distraction, at the completion of the consolidation period, and at 6 and 12 months postoperatively. The aesthetic outcome was excellent and skeletal advancement of 8 and 7 mm was measured without dentoalveolar compensations.