Wide alveolar cleft and midface distraction: Report of a case.

Background: Cleft lip and palate patients often present wide alveolar cleft and midface hypoplasia. Closure of such wide alveolar clefts may be difficult using bone graft. Traditional orthognathic surgery for midface advancement shows relapse. Distraction osteogenesis (DO) as a modality for midface advancement has shown good results with external distractors. Use of internal distractor (ID) further improves patient compliance, causes minimal discomfort and offers the advantage of limiting relapse. The purpose of this study was to evaluate the versatility of intraoral distracters in midface advancement in cases with alveolar cleft.

Method: A 16 years old young girl with midface deficiency and alveolar cleft visited our outpatient clinic for aesthetic improvement and midface distraction was planned. After Le Fort I osteotomy, internal distractor was fixed. A latency period of 5 days was allowed and then distraction was started at the rate of 1 mm per day in two installments. Evaluation was done for closure of cleft, ease of the procedure, stability, and complications. Lateral cephalograms were evaluated at three stages: predistraction; post-distraction; and 1 year post-distraction.

Results: Complete closure of alveolar cleft was observed with 17 mm midface advancement and bone formation at the pterygomaxillary region. Maxillary position improved in relation to the cranial base. The results were stable even at 1 year follow-up.

Conclusion: Distraction osteogenesis using intraoral distractors was successful in alveolar cleft closure, as well as midface advancement in terms of stability of results and patient compliance with minimal complications.