Intraoral-appliance modification to retract the premaxilla in patients with bilateral cleft lip

Management of the protrusive premaxilla in patients with bilateral cleft lip is challenging for the reconstructive team. Several intra- and extraoral orthopedic techniques to reposition the protrusive premaxilla prior to bilateral cleft lip repair have been presented in the literature. A modification to a previously described tissue-borne palatal plate with a latex strap is presented. In the modified plate, the latex strap is replaced by an orthodontic elastomeric chain, and the chain over the prolabium is covered with soft denture liner. This appliance is effective in retracting the premaxilla, noninvasive, easy to construct and adjust, economic, well tolerated by the patient, and accepted by the parents.