Maxillary movement in cleft patients treated with internal tooth borne distractor.

Cleft lip and palate is associated with maxillary hypoplasia and retrognathism. Surgery and distraction have been the most common treatment approaches used. The aim of this study was to objectively assess the quantum and direction of movement of the anterior maxilla in cleft patients treated with an internal tooth borne distractor. A prospective clinical study design was followed in which 8 consecutive patients with cleft maxillary hypoplasia were included in the age range of 15-25 years. All patients had undergone secondary alveolar bone grafting earlier. Anterior maxillary distraction was performed using a tooth borne appliance in all 8 patients after necessary osteotomy. Lateral cephalograms were obtained preoperatively, predistraction and postdistraction. The angular and linear change at the maxillary anterior segment, rotation of the palatal plane, mandibular plane, increase in lower facial height and vertical changes of the anterior and posterior dentoalveolar segments were measured. The movement of the anterior maxillary segment was demonstrated anteriorly and superiorly in all the patients. The anterior and posterior dentoalveolar heights were increased post-distraction. There was also an increase in lower anterior facial height and the mandibular plane angle. Predictable superior and anterior movement of the anterior maxilla along with significant increase in palatal length could be achieved with the internal tooth borne distractor leading to remarkable improvement in esthetics and better function.