Rotational movement of the anterior maxillary segment by hybrid distractor in patients with cleft lip and palate

Objective: Maxillary anterior segmental distraction osteogenesis (MASDO) is an effective surgical orthodontic treatment for the retruded maxilla in cleft lip and palate because of its benefit of the conservation of velopharyngeal function. Some reports showed MASDO using various devices, but they do not allow the rotational movement of the distracted anterior segment. In this article, we showed MASDO using hybrid distracters (DynaForm System: Stryker Osteosymthesis, Leibinger Micro Implants, Kalamazoo, MI), which allow the advance of the distracted segment with rotational movement. Method: The hybrid distractor with 4 metal arms is secured beyond both alveolar osteotomy lines on each side. These 2 distractors permit rotational movement of the segment by controlling the amount of advancement on each side. Results: For 6 patients with cleft lip and palate, MASDO using hybrid distractors was performed and the anterior segment moved at planned positions without any complications except lip discomfort, which disappeared after removal of the distractor. Conclusion: MASDO, using an institutionally diagnosed hybrid distractor can successfully achieve the necessary rotational movements of the anterior maxillary segment owing to its design, which incorporates some mechanical flexibility.