Anterior Maxillary Distraction as an Interim Procedure for Management of Cleft Maxillary Hypoplasia

IntroductionManagement of cleft maxillary hypoplasia (CMH) is complex and influenced by multiple factors. While orthognathic surgery (OGS) remains a standard corrective approach, large maxillary advancement often result in compromised stability. Alternative methods, such as anterior maxillary distraction (AMD) and Le Fort 1 distraction, offer gradual advancement but may not address CMH in all dimensions. This study assesses the efficacy of staging CMH treatment using both AMD and OGS.DesignRetrospective Observational Study.PatientsUnilateral cleft lip and palate patients with at least 1 year of follow-up post-CMH correction were included.InterventionPatients were grouped by maxillary arch perimeter (MAP) and intervention: Group A (<80 mm, AMD + OGS), Group B (>90 mm, OGS only), and Group C (<80 mm, OGS only). Maxillary arch perimeter changes, OGS movement, relapse, and postoperative orthodontic treatment duration were evaluated.ResultsFifteen patients (5 per group) were included. Group A showed increased MAP by 7.84 mm post-AMD, accommodating palatally placed teeth. Mean maxillary movement during OGS was comparable in Group A (7.4 mm) and Group B (7.5 mm) but greater in Group C (11.8 mm). Relapse was the least in Group B, followed by Group A and then C. Postoperative orthodontic duration varied: 4 to 6 months for Group A, 3 to 5 months for Group B, and 12 to 16 months for Group C.ConclusionAnterior maxillary distraction effectively addresses crowding, maintains Bolton's ratio, increases MAP, and reduces the quantum of movement during subsequent OGS. A preoperative MAP ≥ 85 mm allowed good interarch intercuspation improving stability during OGS and reduced postoperative orthodontic duration. Anterior maxillary distraction proves to be a valuable interim procedure, enhancing overall treatment outcomes in CMH correction.