title: Treatment of maxillary cleft palate: Distraction osteogenesis vs. orthognathic surgery.
abstract: OBJECTIVE
  The purpose of this paper is to compare the treatment of hypoplastic, retruded maxillary cleft palate using distraction osteogenesis vs. orthognathic surgery in terms of stability and relapse, growth after distraction and soft tissue profile changes.
  
  
  METHODS
  The cleft patients showed anteroposterior maxillary hypoplasia with class III malocclusion and negative overjet resulting in a concave profile according to preoperative cephalometric measurements, dental relationship, and soft tissue analysis. The patients were divided in two groups of treatment : S0 eventeen were treated by orthognathic Le Fort I osteotomy fixed with four mini plates and 2 mm screws, and 19 were treated by maxillary distraction osteogenesis with rigid extraoral devices (RED) connected after a Le Fort I osteotomy. The rate of distraction was 1 mm per day to achieve Class I occlusion with slight overcorrection and to create facial profile convexity. Following a 10 week latency period the distraction devices were removed.
  
  
  RESULTS
  In the RED group the maxilla was advanced an average of 15.80 mm. The occlusion changed from class III to class I. The profile of the face changed from concave to convex. At a 1-year follow up the results were stable. The mean orthognathic movement was 8.4 mm.
  
  
  CONCLUSIONS
  In mild maxillary deficiency a one stage orthognathic surgery is preferable. However, in patients requiring moderate to large advancements with significant structural deficiencies of the maxilla or in growing patients the distraction technique is preferred.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Rambam Medical Center, Haifa, Israel.
authors.forename: Adi
authors.initials: A
authors.lastname: Rachmiel
authors.forename: Michal
authors.initials: M
authors.lastname: Even-Almos
authors.forename: Dror
authors.initials: D
authors.lastname: Aizenbud
keywords: Distraction osteogenesis; cleft palate; micrognathism