Management of Maxillary Deformities in Growing Cleft Patients

  • Eric J. W. Liou
  • Philip K. T. Chen


The maxillary deformities in growing cleft patients could be a hypoplastic maxilla, downward and/or laterally displaced premaxilla in bilateral clefts, wide alveolar cleft and fistula, or combinations of the above deformities. It is a challenge for both orthodontist and surgeon to treat a hypoplastic maxilla with wide alveolar cleft in a growing unilateral or bilateral cleft patient or a downward or laterally displaced premaxilla with wide alveolar cleft and fistula in a growing bilateral cleft patient.


Distraction Osteogenesis Maxillary Incisor Orthodontic Tooth Movement Rapid Maxillary Expansion Distraction Device 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Akkaya S, Lorenzon S, Ucem TT (1999) A comparison of sagittal and vertical effects between bonded rapid and slow maxillary expansion procedures. Eur J Orthod 21:175–180PubMedCrossRefGoogle Scholar
  2. Alcan T, Keles A, Erverdi N (2000) The effects of a modified protraction headgear on maxilla. Am J Orthod Dentofacial Orthop 117:27–38PubMedCrossRefGoogle Scholar
  3. Bardach J, Morris HL, Olin WH, Gray SD, Jones DL, Kelly KM, Shaw WC, Semb G (1992) Results of multidisciplinary management of bilateral cleft lip and palate at Iowa cleft center. Plast Reconstr Surg 89:419–435PubMedCrossRefGoogle Scholar
  4. Biederman W, Chem B (1973) Rapid correction of Class III malocclusion by midpalatal expansion. Am J Orthod 63:47–55PubMedCrossRefGoogle Scholar
  5. Boyne PJ (1974) Use of marrow-cancellous bone grafts in maxillary alveolar and palatal clefts. J Dent Res 53:821–824PubMedCrossRefGoogle Scholar
  6. Braun S, Bottrel JA, Lee KG, Lunazzi JJ, Legan HL (2000) The biomechanics of rapid maxillary sutural expansion. Am J Orthod Dentofacial Orthop 118:257–261PubMedCrossRefGoogle Scholar
  7. Castello JR, Olaso AS, Chao JJ, McCarthy JG, Molina F (2000) Craniofacial shortening by contraction osteogenesis: an experimental model. Plast Reconstr Surg 105:617–625PubMedCrossRefGoogle Scholar
  8. Chaconas SJ, Caputo AA (1982) Observation of orthopedic force distribution produced by maxillary orthodontic appliances. Am J Orthod 82(6):492–501PubMedCrossRefGoogle Scholar
  9. Cozza P, Giancotti A, Petrosino A (2001) Rapid palatal expansion in mixed dentition using a modified expander: a cephalometric investigation. J Orthod 28:129–134PubMedCrossRefGoogle Scholar
  10. Da Silva Filho OG, Boas MC, Capelozza Filho L (1991) Rapid maxillary expansion in the primary and mixed dentitions: a cephalometric evaluation. Am J Orthod Dentofacial Orthop 100:171–179PubMedCrossRefGoogle Scholar
  11. Franchi L, Baccetti T, McNamara JA Jr (2000) Mandibular growth as related to cervical vertebral maturation and body height. Am J Orthod Dentofacial Orthop 118:335–340PubMedCrossRefGoogle Scholar
  12. Freihofer HPM, Van Damme PHA, Kuijpers-Jagtman AM (1991) Early secondary osteotomy stabilization of premaxilla in bilateral clefts. J Craniomaxillofac Surg 19:2–6PubMedCrossRefGoogle Scholar
  13. Friede H, Pruzansky S (1972) Longitudinal study of growth in bilateral cleft lip and palate from infancy to adolescence. Plast Reconstr Surg 49:392–403PubMedCrossRefGoogle Scholar
  14. Friede H, Pruzansky S (1985) Long-term effects of premaxillary setback on facial skeletal profile in complete bilateral cleft lip and palate. Cleft Palate J 22:97–105PubMedGoogle Scholar
  15. Haas AJ (1961) Rapid expansion of the maxillary dental arch and nasal cavity by opening the midpalatal suture. Angle Orthod 31:73–90Google Scholar
  16. Haas AJ (1965) Treatment of maxillary deficiency by opening the midpalatal suture. Angle Orthod 35:200–217PubMedGoogle Scholar
  17. Haas AJ (1970) Palatal expansion: just the beginning of dentofacial orthopedics. Am J Orthod 57:219–255PubMedCrossRefGoogle Scholar
  18. Haas AJ (1980) Long-term posttreatment evaluation of rapid palatal expansion. Angle Orthod 50:189–217PubMedGoogle Scholar
  19. Haas AJ (2000) The nonsurgical treatment of the skeletal Class III. Book of abstract, American Association of Orthodontists 100th annual session, p 85Google Scholar
  20. Harvold EP (1961) Cephalometric roentgenography in the study of cleft lip and palate. In: Pruzansky S (ed) Congenital anomalies of the face and associated structures. Charles C. Thomas, Springfield, pp 329–336Google Scholar
  21. Hayward JR (1983) Management of the premaxilla in bilateral clefts. J Oral Maxillofac Surg 41:518–524PubMedCrossRefGoogle Scholar
  22. Heidbuchel K, Kuijpers-Jagtman AM, Freihofer HPM (1993) An orthodontic and cephalometric study on the results of the combined approach of the protruded premaxilla in bilateral clefts. J Craniomaxillofac Surg 21:60–66PubMedCrossRefGoogle Scholar
  23. Iino M, Sasaki T, Kochi S, Fukuda M, Takahashi T, Yamaguchi T (1998) Surgical repositioning of the premaxilla in combination with two-stage alveolar bone grafting in bilateral cleft lip and palate. Cleft Palate Craniofac J 35:304–309PubMedCrossRefGoogle Scholar
  24. Itoh T (1985) Photoelastic effect of maxillary protraction on the craniofacial complex. Am J Orthod 88:117–124PubMedCrossRefGoogle Scholar
  25. Jackson IT (1972) Closure of secondary palatal fistula with intraoral tissue and bone grafting. Br J Plast Surg 25:93–105PubMedCrossRefGoogle Scholar
  26. Kawakami T, Nishimoto M, Matsuda Y, Deguchi T, Eda S (1996) Histological suture changes following retraction of the maxillary anterior bone segment after corticotomy. Endod Dent Traumatol 12:38–43PubMedCrossRefGoogle Scholar
  27. Kawakami M, Yagi T, Takada K (2002) Maxillary expansion and protraction in correction of midface retrusion in a complete unilateral cleft lip and palate patient. Angle Orthod 72:355–361PubMedGoogle Scholar
  28. Lee KG, Ryu YK, Park YC, Rudolph DJ (1997) A study of holographic interferometry on the initial reaction of maxillofacial complex during protraction. Am J Orthod Dentofacial Orthop 111:623–632PubMedCrossRefGoogle Scholar
  29. Levrini L, Filippi V (1999) A fan-shaped maxillary expander. J Clin Orthod 33(11):642–643PubMedGoogle Scholar
  30. Lin JCY, Liou EJW (2003) A new bone screw for orthodontic anchorage. J Clin Orthod 37:676–681PubMedGoogle Scholar
  31. Liou EJW, Chen PKT (2003) New orthodontic and orthopedic managements on the premaxillary deformities in patients with bilateral cleft before alveolar bone grafting. Ann Coll Surg HK 7:73–82CrossRefGoogle Scholar
  32. Liou EJW, Tsai WC (2005) A new protocol for maxillary protraction in cleft patients: repetitive weekly protocol of alternate rapid maxillary expansions and constrictions. Cleft Palate Craniofac J 42:121–127PubMedCrossRefGoogle Scholar
  33. Liou EJ, Chen KT, Chen RY, Huang CS (2000) Interdental distraction osteogenesis and rapid orthodontic tooth movement: a novel approach to approximate wide alveolar cleft or bony defect. Plast Reconstr Surg 105:1262–1272PubMedGoogle Scholar
  34. Liou EJW, Chen PKT, Huang CS, Chen YR (2004) Orthopedic intrusion of premaxilla with distraction device before alveolar bone grafting in patients with bilateral cleft lip and palate. Plast Reconstr Surg 113:818–826PubMedCrossRefGoogle Scholar
  35. Liu C, Song R, Song Y (2000) Sutural expansion osteogenesis for management of the bony-tissue defect in cleft palate repair: experimental studies in dogs. Plast Reconstr Surg 105:2012–2025PubMedCrossRefGoogle Scholar
  36. McNamara JA Jr (1987) An orthopedic approach to the treatment of Class III malocclusion in young patients. J Clin Orthod 21:598–608PubMedGoogle Scholar
  37. Mito T, Sato K, Mitani H (2003) Predicting mandibular growth potential with cervical vertebral bone age. Am J Orthod Dentofacial Orthop 124:173–177PubMedCrossRefGoogle Scholar
  38. Nanda R, Sugawara J, Topazian RG (1983) Effect of maxillary osteotomy on subsequent craniofacial growth in adolescent monkeys. Am J Orthod 83:391–407PubMedCrossRefGoogle Scholar
  39. Narula JD, Ross RB (1970) Facial growth in children with complete bilateral cleft lip and palate. Cleft Palate J 7:239–248PubMedGoogle Scholar
  40. Pangrazio-Kulbersh V, Berger J, Kersten G (1998) Effects of protration mechanics on the midface. Am J Orthod Dentofacial Orthop 114:484–491PubMedCrossRefGoogle Scholar
  41. Posnick JC, Tompson B (1995) Cleft-orthognathic surgery: complications and long-term results. Plast Reconstr Surg 96:255–266PubMedCrossRefGoogle Scholar
  42. Pruzansky S (1955) Factors determining arch form in cleft of the lip and palate. Am J Orthod 41:827–851CrossRefGoogle Scholar
  43. Sarver DM, Johnston MW (1989) Skeletal changes in vertical and anterior displacement of the maxilla with bonded rapid palatal expansion appliances. Am J Orthod Dentofacial Orthop 95:462–466PubMedCrossRefGoogle Scholar
  44. Smahel Z (1984) Craniofacial morphology in adults with bilateral complete cleft lip and palate. Cleft Palate J 21:159–169PubMedGoogle Scholar
  45. Suzuki A, Takahama Y (1989) A jointed fan-type expander: a newly designed expansion appliance for the upper dental arch of patients with cleft lip and/or palate. Cleft Palate J 26(3):239–241PubMedGoogle Scholar
  46. Tindlund RS (1994) Skeletal response to maxillary protraction in patients with cleft lip and palate before age 10 years. Cleft Palate Craniofac J 31:295–308PubMedCrossRefGoogle Scholar
  47. Tindlund RS, Rygh P (1993) Soft-tissue profile changes during widening and protraction of the maxilla in patients with cleft lip and palate compared with normal growth and development. Cleft Palate Craniofac J 30:454–468PubMedCrossRefGoogle Scholar
  48. Trotman CA, Ross RB (1993) Craniofacial growth in bilateral cleft lip and palate: ages six years to adulthood. Cleft Palate Craniofac J 30:261–273PubMedCrossRefGoogle Scholar
  49. Turley PK (1988) Orthopedic correction of Class III malocclusion with palatal expansion and custom protraction headgear. J Clin Orthod 22:314–325PubMedGoogle Scholar
  50. Vardimon AD, Brosh T, Spiegler A, Lieberman M, Pitaru S (1998) Rapid palatal expansion: part 1. Mineralization pattern of the midpalatal suture in cats. Am J Orthod Dentofacial Orthop 113:371–378PubMedGoogle Scholar
  51. Vargervik K (1983) Growth characteristics of the premaxilla and orthodontic treatment principles in bilateral cleft lip and palate. Cleft Palate J 20:289–302PubMedGoogle Scholar
  52. Wertz RA (1970) Skeletal and dental changes accompanying rapid midpalatal suture opening. Am J Orthod 58:41–66PubMedCrossRefGoogle Scholar

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© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Department of Orthodontics & Craniofacial DentistryChang Gung Memorial HospitalTaipeiTaiwan
  2. 2.Section of Craniofacial Surgery, Department of Plastic and Reconstruction SurgeryChang Gung Memorial HospitalTaipeiTaiwan

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