Forward traction of the maxilla in cleft lip and palate patients

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Abstract
The effect of forward maxillary traction from an extraoral appliance was studied in four patients with complete unilateral cleft lip and palate. Primary surgical treatment included various methods of lip surgery and palatal closure by the push-back technique. One of the patients had two periosteoplasty procedures in infancy and another patients underwent bone grafting in combination with fistula closure at the age of 8½ years. Traction on the maxilla was initiated at ages between 8 and 13 years and its duration varied between 7 months and 4 years. The effect of the treatment was analyzed by means of roentgencephalometry, in combination with metallic implants in three of the patients, and by dental casts. The effect on the basal maxilla was favourable in two of the patients. The poor result in one of the other subjects was ascribed to the palatal bone graft, which may have prevented forward sliding of the maxilla, and in the other patient to lack of cooperation and possibly to the influence of the periosteoplasty. Side-effects of treatment included protrusion of the maxillary dentition and transient retrusion of the mandible. It was concluded that forward maxillary traction has a beneficial effect on the retrognathic mid-face of children with cleft lip and palate provided that the displacement of the maxilla is not blocked, e.g. by a bone graft.

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