PMC5996656_01
Initial facial and intraoral photographs of our patient who was diagnosed with angles Class I malocclusion, a skeletal Class III jaw relationship with a concave profile, unilateral anterior crossbite, open bite, distorted Anterior segment with crowding, occlusal distortion, a left-sided cleft lip and palate and oronasal fistula at 13 years of age
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F1
She had a Class I molar relationship on the right and left sides, anterior crossbite with reverse overjet of 4 mm, Unilateral open bite on the left side, palatally positioned 12, partially erupted 22 and incisors are in Class III relationship [Figure 1]. Superimposition of the pre- and post-treatment lateral cephalograms showed a linear movement of maxillary anterior segment by 7 mm [Figure 9 and Table 1].
Pretreatment radiographs. (a) Lateral cephalogram. (b) Occlusal radiograph. (c) Orthopantomogram
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F2
Secondary alveolar bone grafting. (a) Occlusal radiograph at pre grafting stage and (b) Occlusal radiograph 6-month postgrafting stage
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F3
The cleft region was untouched for 6 months for the graft take up [Figure 3].
Treatment simulation using dolphin digital imaging software (Paterson and Kelly, version 11.2)
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F4
To avoid the relapse after the surgery, it is planned to advance up to 9 mm [Figure 4].
Fabrication of Intraoral distraction appliance with hyrax screw and mock surgery
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F5
Anterior segment was consolidated by making a cap splint to prevent the cleft segment from parting away [Figure 5].
Surgical corticotomy and fitting of intraoral appliance for distraction
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F6
Mucoperiosteal flap was closed primarily, custom-made distraction device was cemented to the teeth using glass ionomer cement and checked for its activation [Figure 6].
Distraction device activation and removal
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F7
At the end of this consolidation period, the distractor is removed [Figure 7].
Posttreatment facial and intraoral photographs of the patient with well-aligned maxillary and mandibular arches, change in facial profile, and improved esthetics
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F8
Left lateral incisor was in the cleft region; hence, very mild forces are used to derotate it [Figure 8].
Comparison of pretreatment, posttreatment, and retention phase lateral cephalograms
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F9
Superimposition of the pre- and post-treatment lateral cephalograms showed a linear movement of maxillary anterior segment by 7 mm [Figure 9 and Table 1]. The follow-up retention after 24 months showed a stabilized skeletal pattern with no signs of relapse [Figures 9 and 10].
Retentive phase 24-month extraoral and intraoral radiographs
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F10
The follow-up retention after 24 months showed a stabilized skeletal pattern with no signs of relapse [Figures 9 and 10].