Late Maxillary Protraction: Novel Treatment Modality for Cleft Patients

Cleft lip and palate (CLP) is the most common craniofacial birth defect, occurring in 1/700 live births in the USA. OBJECTIVE: To determine whether a novel Modified Effective Maxillary Orthopedic Protraction (MEMOP) technique developed at CHLA can be an effective non-surgical alternative to orthognathic surgery to treat maxillary hypoplasia in CLP patient population. METHODS: 28 patients with maxillary hypoplasia received treatment using the MEMOP technique. The alternating rapid maxillary expansion and constriction consisted of 7 days of expansion followed by 7 days of constriction, administered over 8 weeks to achieve over-correction of negative overjet. After sutural loosening, patients received Class III elastics with reverse pull headgear treatment at night. The control group of 26 CLP patients completed pubertal growth before Lefort I surgery. Lateral cephalometric were taken at 3 time-points (pre-, immediately after and 6-months post-protraction) for analysis of maxillary length, mandibular length, rotation of the occlusal plane and incisor position. Soft tissue results were compared between post-protraction and post-LeFort 1 CLP patients. RESULTS: In the control group, the Class III malocclusion did not self-correct during adolescent growth. In the protraction group, 4 patients did not complete the protocol and their malocclusion was not corrected. Only 17 of the 28 patients had 6-month post-surgical records. The MEMOP protocol corrected Class III malocclusions ranging from 3-12 mm in 24 patients as measured by the second timepoint. The Cl III correction was attained by a combination of maxillary advancement, mandibular incisor uprighting, maxillary incisors proclination, and counter-clockwise occlusal-plane rotation. The soft tissue change in nasolabial angle was comparable to changes observed in LeFort 1 Maxillary surgery. CONCLUSION: The MEMOP technique demonstrates significant potential as an effective non-surgical treatment to correct the maxillary hypoplasia in cleft lip patients during adolescent growth.