Transmaxillary osteogenic distraction with intraoral tooth-borne distractors

Midfacial retrusion and class III malocclusion in maxillary hypoplasia are frequent sequelae in patients with cleft lip and palate. Similar deformities are seen in craniofacial dysostosis surgically treated in infancy. Recurrences after orthognathic surgery are unpredictable even using rigid fixations. Distraction osteogenesis, using Le Fort I osteotomies with external distractors, is uncomfortable for the patient, and internal distractors require a second procedure for removing the retractor. A new model of distraction osteogenesis is presented. Transmaxillary osteogenic distraction, using tooth-borne devices, is a simple method and allows ambulatory retraction of distractors. Osteogenesis between molars and premolars at the alveolar level is stable and allows orthodontic mobilization and dental implants. Anchorage in molars and maxillary tuberosities avoids velopharyngeal incompetence. Transmaxillary osteogenic distraction techniques are described, as well as results after 7 years of experience in 45 patients with maxillary hypoplasia. Results are satisfactory and stable, surgery is simple, and custom-made intraoral devices are easy to handle with minimal discomfort for the patients.