Maxillary distraction osteogenesis for cleft cases

Maxillary distraction using halo-type devices has been a breakthrough in Le Fort I maxillary advancement for cleft cases, because of the possibilities for three-dimensional correction of the hypoplastic maxilla and the stability of the advanced maxillary segment. In addition, together with the RED Retention Plate System® it allows control of the palatal plane easily during the distraction. We have reported these advantages of halo-type distraction technique, but we have begun to notice the possibility that LeFort I advancement deteriorates the patient's velopharyngeal function in some cases. Furthermore, the skeletal correction with LeFort I advancement for the hyp oplastic maxilla is achieved simply by forcing the small maxillary dental arch to be set for the normal size dental arch of the mandible. Therefore, some of the molars are not involved in occlusion in some cases. To improve these problems, we adopted anterior maxillary distraction osteogenesis (AMDO), similar to interdental distraction osteogenesis, for the cleft cases that exhibited severe hypoplastic maxilla and marginal velopharyngeal insufficiency. Even though problems with AMDO still remain, we expect it could provide an alternative to LeFort I advancement for cleft cases.