Management of severe maxillary hypoplasia with distraction osteogenesis in patients with cleft lip and palate

Maxillary hypoplasia is a common finding in patients with cleft lip and palate. Clinically, this manifests as a concave profile, midface deficiency, and Class III skeletal malocclusion. Management is in accordance with the severity of the malocclusion. In the case of moderate to severe skeletal discrepancy, combined orthodontic and surgical correction is required to obtain optimal results. In most instances, definitive orthognathic surgery is pursued at skeletal maturity. In the most severe cases however, early surgical correction has been achieved with Le Fort I osteotomy and distraction osteogenesis. The technique enables successful correction of a large maxillomandibular discrepancy in a growing patient with stable results. There are also applications in a skeletally mature patient with severe maxillary deficiency.