Use of hyrax distractor in maxillary hypoplasia associated with cleft lip and palate patients

Neeraj Upadhyay, Arun Kumar Singh, Veerendra Prashad, Divya Narayan Upadhyaya

Journal of Cleft Lip Palate and Craniofacial Anomalies 2019 6(1):17-22

Context: Use of hyrax expander for palatal arch lengthening (anteroposterior) is not new, but large series with long-term follow-up is lacking. Aims: The aim of this study was to evaluate surgically assisted rapid maxillary expansion for hypoplastic maxilla, its efficacy, patient's satisfaction, and relapse rates. Settings and Design: A prospective study was done in PGD of Plastic Surgery, KGMU, Lucknow, between October 2014 and December 2015. Subjects and Methods: Fifteen patients with maxillary hypoplasia associated with cleft lip and palate underwent anterior segmental maxillary osteotomy. Distraction of anterior segment was done with a tooth-anchored hyrax expansion screw oriented in anteroposterior direction. Distraction was started on the 7th day. After desired advancement, the device was left intact for a consolidation period of 3 months and follow-up for any complication was done at the end of 6 months. Statistical Analysis Used: IBM SPSS version 20 software was used. Data expressed as number (percentage) and mean ± standard deviation, Student's t-test and ANOVA were used to compare mean between groups. Results: Bony landmarks sella–nasion–A point angle, maxillary length (ANS-PNS), mean space created on one side (mesial border of first molar to distal border of first premolar), and point A-N perpendicular improved significantly (P < 0.001). There was no significant change in vertical height of maxilla. Soft-tissue profile of patient (Sn–G perpendicular) also improved significantly (P < 0.001). No relapse was observed in patient during the 6 months of follow-up. Conclusion: Results of hyrax distractor in maxillary hypoplasia associated with cleft lip and palate patients were highly promising in patients with occlusal discrepancy <8 mm.

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