Introduction: Cleft lip and palate patients can present with a maxillary retrusion with tendency to Class III malocclusion after cleft repair. Within the last few years dististraction osteogenesis has been used as an alternative to maxillary osteotomies and bone grafting in cleft palate maxillary hypoplasia. Aim: This paper presents our experience in using external and internal devices for correction of midface hypoplasia and analyses long-term stability of skeletal and soft tissue changes after maxillary advancement with distraction osteogenesis. Material and Methods : 14 cleft lip and palate patients ,aged 12 to 18 years of age with severe maxillary and mid-face hypoplasia due to bilateral cleft lip and palate ,uiulateral cleft lip and palate , were treated in our centre with two different techniques after complete Le Fort I osteotomy : one group underwent face mask protraction (10 patients ), and other group underwent internal distraction device ( Dynaform Leibinger)( 4 patients ). Facial and occlusal phothographs and lateral cephalometric radiograph were obtained preoperatively, 3 months and 6 months after distraction. A cephalometric analysis was performed to compare the sagital craniofacial and soft tissue morphology before and afterr distraction. Results: In our series of patients undergoing internal and external maxillary distraction, maxilla was significantly advanced. Midface advancement between 10 and 15 vam was achieved in all patients without complications. Maxillary distraction improved the profile by increasing nasal projection, normalizing nasolabial angle, and making the upper lip more prominent The facial concavity turned into facial convexity. The profile changed from a prognatic into an orthognathic face.The final occlusal relation was satisfaing and negative overjets in all patients were corected to normal values. Postdistraction cephalometric evaluation revealed normalization of most of cephalometric values. No relapses were observed. All patients were kept under orthodontic control during distraction. Conclusion: Distraction osteogenesis offers new perspectives in the early treatment of midfacial hypoplasia. The major advantage is the ability to direct and control the maxUla during distraction procedure. MaxiUary distraction is an effective option for maxiUary hypoplasia in cleft patients.

National Research Institute for Mother and Child Centre for Craniofacial Disorders Warsaw PL