Late maxillary protraction techniques for cleft lip and palate

Maxillary protraction has been used in childhood to improve Class III malocclusion in children with cleft lip and palate; however, the correction at this age tends to be temporary and needs to be readdressed after growth is complete. In this article, we discuss methods to combine maxillary protraction with sutural loosening in young adolescents and with LeFort 1 osteotomies in older adolescents. Maxillary protraction depends solely on patient compliance, which is both an advantage and disadvantage. Elastic traction in place of a distractor is less precise and reliable than a fixed distractor. Despite these limitations, maxillary protraction has helped us to treat patients with Class III malocclusions who avoided the morbidity and long recovery periods associated with orthognathic surgery. Several of the current modifications of the protraction protocol are presented. Although it takes hard work, maxillary protraction is a viable alternative to orthognathic surgery if the patient is responsible and motivated.