New concept of maxillary distraction in adolescent patients with cleft lip and palate

Objectives: This study aimed to evaluate the clinical outcomes of intraoral maxillary distraction osteogenesis (DO) as a staged treatment strategy in adolescent patients with cleft lip and/or palate (CLP), severe maxillary hypoplasia, and midfacial growth deficiency. Patients and Methods: Five patients (one male and four females; mean age, 15 years 11 months) who underwent maxillary DO between 2020 and 2025 were included. After preoperative computer-assisted three-dimensional virtual planning to determine the distraction vector and distractor placement, Le Fort I osteotomy and intraoral distractors were placed. Following bilateral distraction at 1.0 mm/day per side after 3 to 4 days latency and approximately 3 months consolidation period, the distractor was removed and the maxilla was fixed at the zygomatic buttress using bioresorbable plates. Skeletal changes were evaluated using lateral cephalograms obtained at T0 (preoperative), T1 (after distractor removal), and T2 (1 year after surgery). Results: The mean operative time was 64 minutes. In all patients, distraction was completed without intraoperative modification of the distraction vector or placement of the distractor. Mean linear movement of point A at T1 was 11.0 mm, including 8.9 mm horizontally and 5.7 mm vertically. Mean relapse of point A from T1 to T2 was 2.3 mm (25.7%) horizontally and 2.1 mm (37.5%) vertically. Despite this relapse, point A at T2 showed a mean anteroinferior movement of 7.5 mm relative to that at T0. Major complications were not observed. Serial videoendoscopic evaluations revealed no apparent deterioration in soft palate or pharyngeal wall movements during the treatments. Four patients subsequently underwent definitive orthognathic surgery, whereas one patient achieved a favorable skeletal and occlusal relationship with distraction alone. Conclusion: Intraoral maxillary DO may be a useful staged treatment option for adolescents with CLP and severe maxillary hypoplasia, providing skeletal improvement before definitive orthognathic surgery.