1 International Journal of Medical and Dental Case Reports (2018), Article ID 060324, 4 Pages CASE REPORT Anterior maxillary distraction osteogenesis for cleft lip and palate patients - A case series Pratham Pai, V. M. Nitin, N. Raghunath, Paridhi Gupta Department of Orthodontics & Dentofacial Orthopedics, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India Abstract Distraction osteogenesis (DO) has become a mainstream surgical technique for patients with jaw deformities. This case report describes the surgical orthodontic treatment of maxillary hypoplasia in two patients of 14–19 years with cleft lip and palate. They were treated with anterior maxillary DO using rigid intraoral distractor device. Distraction was started after the initial latency period with activation of 0.8 mm/day until positive overjet was gained. Cephalometric analysis was performed twice for evaluation: Before surgery (Pre-Rx) and after distraction (Post-Rx). Both the distractions completed smoothly and maxilla was distracted efciently. Maxillary prominence increased in both the patients with a positive overjet after distraction. DO provided an efective way to correct maxillary hypoplasia secondary to cleft lip and palate. Keywords: Cleft lip and palate, distraction osteogenesis, maxillary defciency Correspondence Dr. Pratham Pai, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India. E-mail: prats92pai@gmail.com Received 04 February 2019; Accepted 01 March 2019 doi: 10.15713/ins.ijmdcr.112 How to cite the article: Pai P, Nitin VM, Raghunath N, Gupta P. Anterior maxillary distraction osteogenesis for cleft lip and palate patients - A case series. Int J Med Dent Case Rep 2018;5:1-4. Introduction Cleft palate is one of the most prevalent congenital craniofacial birth defects in human. In general, the palatoplasty and pharyngoplasty are performed on such patients at an early age to obtain good velopharyngeal closure. [1] As early as 1954, Herfert suggested that the palatoplasty could damage the growth center of maxilla, thus interfering with the maxillofacial growth, leading to hypoplasia. [2] Bardach and Kelly indicated that severe interference of the maxillary growth usually is caused by the contraction of the scar on the palate. [3] Recently, distraction osteogenesis (DO) has evolved as a new mainstream surgical technique for patients with such jaw deformities. It can be performed on both the mandible and the maxilla. Maxillary DO was proposed in 1997 using a rigid external distraction device. DO can provide skeletal advancement along with expansion of soft tissue and is regarded as highly efective surgical technique for patients with jaw deformities. [4] DO has shown excellent results in maintaining stability. DO outweighs the traditional methods of craniofacial reconstruction by its ability to generate new bone and reduced morbidity rate. In addition, advancement by DO is not as limited as conventional osteotomies. [5,6] Case Report The study consisted of two female patients of 14–19 years of age. Both patients sufered from cleft lip and palate deformity with a hypoplastic maxilla. The pre-treatment fndings of both the patients have been enlisted in Table 1. Written informed consent in regional language was obtained from both the patients. Treatment objective The objective was to correct the following parameters: • Hypoplastic maxilla by forward repositioning • Anterior and posterior crossbites • Reverse overjet and overbite • Molar and canine relationship. Treatment alternatives Anterior movement of maxilla by Le Fort 1 orthognathic surgery was an alternative treatment for these cases. However, due to the possibility of aggravation of hypernasality in the patients after Le Fort 1 osteotomy, DO of anterior maxilla was chosen as the treatment plan. The reason is that the velopharyngeal area will remain intact after the anterior DO procedure. Treatment protocol Both the patients underwent fxed orthodontics in both upper and lower arch with standard 0.022 pre-adjusted edgewise prescription.