title: Rapid maxillary distraction protocol utilizing the halo distraction system and rigid internal fixation.
abstract: OBJECTIVE
  To shorten head frame wear time associated with external halo distraction (HD), we have adapted a protocol for maxillary distraction with the halo system that integrates plate fixation.
  
  
  METHODS
  All patients had a history of cleft lip and/or palate and maxillary retrusion > or = 8 mm. Five patients treated with this protocol and followed for at least 1 year were included in this study.
  
  
  METHODS
  The protocol included a 3-day latency period, variable maxillary distraction, and removal of the halo device with simultaneous rigid internal fixation. Two patients had a variable period of maxillomandibular fixation (MMF), which maintained the maxillary advancement and idealized intercuspal position while permitting further callus maturation. Cephalographs were obtained preoperatively, immediately following distractor removal, and 1 year after rigid internal fixation.
  
  
  RESULTS
  The mean age at time of surgery was 18.7 years. The maxillary deficiency ranged from 8 to 15 mm (mean = 10.6 mm). All five patients demonstrated excellent occlusion. Cephalometric analysis 1-year post rigid internal fixation revealed minimal (<1 mm) skeletal relapse.
  
  
  CONCLUSIONS
  Rapid maxillary distraction followed by MMF to maintain maxillary advancement may reduce halo device wear to 1 to 2 weeks. MMF optimizes occlusion by forcing the maxillary teeth into maximal intercuspal position. Rigid fixation is not only associated with less long-term relapse compared to nonrigid forms of fixation, but also minimizes the incidence of nonunion. This treatment protocol provides the advancement possible with distraction osteogenesis and the accuracy of orthognathic surgery, thereby minimizing external head frame wear.
authors.affiliation: Georgetown University Hospital, Washington, DC, USA.
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Baker
authors.forename: Russell R
authors.initials: RR
authors.lastname: Reid
authors.forename: Brooke
authors.initials: B
authors.lastname: Burkey
authors.forename: Scott P
authors.initials: SP
authors.lastname: Bartlett
mesh_terms: D000293:Adolescent; D001860:Bone Plates; D002508:Cephalometry; D002972:Cleft Palate / Q000150:complications; D005115:Extraoral Traction Appliances; D005260:Female; D006801:Humans; D019248:Jaw Fixation Techniques / Q000295:instrumentation; D008297:Male; D008437:Maxilla / Q000601:surgery*; D019647:Oral Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D019857:Osteogenesis, Distraction / Q000295:instrumentation / Q000379:methods*; D063173:Retrognathia / Q000150:complications / Q000601:surgery*