**2. Traditional treatment options for maxillary hypoplasia**

Patients with maxillary hypoplasia secondary to orofacial cleft present multiple challenging problems. Traditional orthodontic/orthopaedic approaches to treat these patients, while sometimes successful in obtaining stable occlusal relationships, often fall short of expectations with respect to facial balance and aesthetics.

Usual treatment sequence can be explained as follows: (1) at the ages of 5–7 years orthodontic expansion apparatus can be used such as Quad Helix, Spring jet appliance or Hyrax type palatal expanders (**Figure 1**); (2) protraction with facial mask is used at 8 years or later (**Figure 2**); (3) bone grafting harvested from iliac crest is performed at 7–9 years of age (**Figure 3**). To overcome three-dimensional constriction of the maxilla due to the previous surgical scars, different types of therapeutic concepts are used [6].

The patient with complete unilateral cleft lip and palate shown below (**Figures 1**–**4**) was a rare case that could be treated in terms of only orthodontics and orthopaedics. However, most of

**Figure 1.** An alternative type of maxillary expansion apparatus (Modified spring jet appliance) used in UCLP patients to achieve appropriate transversal dimension in the maxillary arch.

the patients need surgical intervention to overcome both intrinsic and iatrogenic factors that caused serious maxillary hypoplasia.

**Figure 2.** Maxillary sagittal protraction with Delaire type facial mask.

successfully and many other internal devices have been introduced for better results regard‐

Patients with cleft lip and palate and maxillary hypoplasia usually present with a collapsed maxillary dental arch and impaired forward and downward growth of the maxilla [2–4]. Two factors have been proposed for the growth deficiency [2]: One such factor is the intrinsic factor, mainly introduced by developmental deficiency leading to the formation of a cleft and the growth potential of midfacial skeleton. The other factor is the iatrogenic factor, including surgical repair. Therefore, management of cleft-related maxillary hypoplasia is more complex due to the larger degree of malocclusion and advancement, the risk of post-surgical relapse and the potential velopharyngeal incompetence following maxillary advancement [1, 5].

The general aim of this chapter is to present a brief review of sagittal distraction osteogenesis in sagittal maxillofacial advancement and the biomechanical effects of maxillary sagittal distraction osteogenesis both in patients with unilateral cleft lip and palate and in patients with

Patients with maxillary hypoplasia secondary to orofacial cleft present multiple challenging problems. Traditional orthodontic/orthopaedic approaches to treat these patients, while sometimes successful in obtaining stable occlusal relationships, often fall short of expectations

Usual treatment sequence can be explained as follows: (1) at the ages of 5–7 years orthodontic expansion apparatus can be used such as Quad Helix, Spring jet appliance or Hyrax type palatal expanders (**Figure 1**); (2) protraction with facial mask is used at 8 years or later (**Figure 2**); (3) bone grafting harvested from iliac crest is performed at 7–9 years of age (**Figure 3**). To overcome three-dimensional constriction of the maxilla due to the previous

The patient with complete unilateral cleft lip and palate shown below (**Figures 1**–**4**) was a rare case that could be treated in terms of only orthodontics and orthopaedics. However, most of

**Figure 1.** An alternative type of maxillary expansion apparatus (Modified spring jet appliance) used in UCLP patients

**2. Traditional treatment options for maxillary hypoplasia**

surgical scars, different types of therapeutic concepts are used [6].

to achieve appropriate transversal dimension in the maxillary arch.

with respect to facial balance and aesthetics.

ing the patient's comfort [1].

66 Advanced Techniques in Bone Regeneration

no cleft.

**Figure 3.** Secondary alveolar bone grafting harvested from iliac crest of the patient.

**Figure 4.** Clinical appearance of the patient one year after both orthopaedic and orthodontic treatment (**Figures 1**–**4** reprinted [6]).
