title: Limitations of internal distraction devices in mature patients with cleft lip and palate and severe midface hypoplasia.
abstract: OBJECTIVE
  We evaluated case-sensitive limitations of internal distraction devices (IDDs) to reveal further options for satisfactory outcomes.
  
  
  METHODS
  Two male cleft patients aged 22 years (P1) and 20 years (P2) with severe maxillary hypoplasia were treated over 18 months. Cephalometric analyses and analyses of A-point movements by superimposing lateral cephalograms were done before and after activation of IDDs and after bimaxillary surgery (BIMAX).
  
  
  RESULTS
  After activating IDDs, the vectors deviated and clockwise rotation of the maxilla and vectors occurred. After 8 months, BIMAX was needed to carry out further maxillary advancement.
  
  
  CONCLUSIONS
  IDDs could pave the way to achieve maximal advancement with BIMAX in a second step and justify the overall treatment when comparing the initial situation with outcome.
authors.affiliation: Department of Oral- and Maxillofacial Surgery, Clinic Centre Bremen-Mitte, School of Medicine of the University of Göttingen, St.-Jürgenstraße 1, 28177 Bremen, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Rustemeyer
authors.forename: Alexander
authors.initials: A
authors.lastname: Busch
authors.forename: Andreas
authors.initials: A
authors.lastname: Bremerich