单侧完全性唇腭裂患儿术前正畸及手术前后的上腭裂隙变化

目的 探讨单侧完全性唇腭裂患儿术前正畸及手术前后的上腭裂隙变化.方法 对18例单侧完全性唇腭裂患儿先用上颌腭托矫治器(PNAM)术前正畸治疗后,再进行唇裂修补手术.采用模型测量方法,比较患儿初诊时、手术前1个月和手术后2个月时的上腭裂隙变化.结果 治疗后患儿唇部外形明显改善,腭部裂隙减小,患侧塌陷的鼻翼穹隆高度恢复.结...     

Three-Dimensional Comparison in Palatal Forms Between Modified Presurgical Nasoalveolar Molding Plate and Hotz's Plate Applied to the Infants With Unilateral Cleft Lip and Palate

The presurgical nasoalveolar molding plate appliance with stent (PNAM) extended from the palatal molding plate; to correct the nostril shape of infants with cleft lip and palate is well known. The PNAM appliance is based on the finding that a high degree of plasticity is maintained in the cartilage of infants during the first 6 weeks after birth. However, on the current PNAM protocol described by Grayson et al. the nasal stent is supposed to be an adjunct to the palatal molding plate after reducing the severity of the alveolar cleft width. We have used the modified Hotz's plate from the setup model and built up the nasal stent even before reducing the severity of the alveolar deformity. In this study we assess the effects of the modified Hotz's plate and the modified PNAM appliance for the alveolar and palatal form. The lateral deviation of the incisal point, the width of the palatal cleft, and the degree of curvature of the palatal vault were first evaluated on plaster models. The PNAM group is smaller on the lateral deviation of the incisal point than the modified Hotz's group. The decreased average width of the palatal cleft and curvature of the palate, was almost the same in both the modified Hotz's and PNAM groups. In comparison with the modified Hotz's plate, the modified PNAM appliance also improves the molding of the alveolar segments and reduces cleft width.     

术前鼻牙槽塑形术对婴儿期单侧完全性唇腭裂颌面三维形态影响的初步研究

目的研究婴儿期单侧完全性唇腭裂修复术前鼻牙槽塑形术及唇裂修复术期间颌面部表面形貌发育变化情况。 方法临床征集2019—2021年间南京市口腔医院口腔修复科收治单侧完全性唇腭裂患儿,筛选出10例纳入研究（6例男婴、4例女婴）,首次就诊均为出生后2周内,即行术前鼻牙槽塑形术,约3个月龄时行唇裂修复手术;治疗期间连续定期应用3dMD面部三维系统进行颌面部表面扫描,术前矫治期内时间点选择以每隔2周为1个临床记录时间（即患儿出生后第2、4、6、8、10和12周）,后续以唇裂修复手术后1周、术后6个月各为1个记录时间点,共计8个时间节点。每次收集唇腭裂患儿面部14个软组织标志点信息,并进一步分成唇部生长发育指标、鼻部生长发育指标和鼻部畸形发育指标三部分,并采用SPSS 19.0应用配对t检验对数据进行统计学分析。 结果鼻翼长度（ac′-prn）由（18.5 ± 1.6）mm减小为（17.1 ± 1.0）mm,差异有统计学意义（t = 4.03,P = 0.003）,鼻底宽度（sbal′-sn）由（20.5 ± 3.5）mm减小为（17.7 ± 3.3）mm,差异有统计学意义（t = 3.91,P = 0.004）,鼻小柱高度（sn″-c′）由（1.8 ± 0.4）mm增加为（4.7 ± 0.6）mm,差异有统计学意义（t = 4.12,P = 0.003）,矫治术前、术后对比差异均具有统计学意义;唇裂修复术后1周,患侧指标鼻小柱高度（sn″-c′）由（4.7 ± 0.6）mm增加为（5.8 ± 0.6）mm,差异有统计学意义（t = 3.41,P = 0.008）,唇高唇长增加,鼻底宽度及鼻翼长度减小,鼻小柱偏斜角度（∠α）由（29.0 ± 12.7）°减小为（5.3 ± 3.4）°,差异有统计学意义（t = 6.34,P<0.001）,健侧指标唇裂术前、术后差异均无统计学意义（P>0.05）。唇裂修复术后6个月,健侧唇部和鼻部生长发育指标保持增长趋势,患侧指标则基本保持不变。 结论术前矫治期间单侧完全性唇腭裂患儿鼻小柱高度逐渐增加、鼻翼形态改善明显,而患侧唇部和健侧鼻唇部生长发育未受限制,唇裂修复术后单侧完全性唇腭裂患儿健患侧鼻唇三角区形态对称性提高,并于术后6个月可保持治疗效果。     

Effects of cheiloplasty on maxillary dental arch development in infants with unilateral complete cleft lip and palate.

OBJECTIVE: To identify and analyze quantitatively the development of the maxillary dental arch before and after cheiloplasty. DESIGN: Prospective, longitudinal study of maxillary dental arch development at age of 1, 3, 6, and 12 months. SETTING: All patients were treated at a university hospital craniofacial center. PATIENTS: Twenty-seven infants with nonsyndromic, unilateral complete cleft lip and palate. INTERVENTION: Millard's rotation-advancement cheiloplasty was performed between the ages of 3 and 4 months. RESULTS: The anterior portion of the nonclefted segment (I-G), anterior ridge length of the nonclefted segment (I-C), and anterior ridge length of the clefted segment (L-C') continuously increased from 1 to 12 months of age. The anterior cleft width (G-L), anterior arch depth (I perpendicular to CC'), anterior basal angle (angle GC-CC'), and anterior arch curature angle (angle GIC) continuously decreased after the cheiloplasty. CONCLUSIONS: Cheiloplasty could mold the anterior portion of the maxillary dental arch palatally by exerting continuous pressure.     

Postnatal treatment factors affecting craniofacial morphology of unilateral cleft lip and palate (UCLP) patients in a Japanese population

We have evaluated the craniofacial morphology of Japanese patients with unilateral cleft lip and palate (UCLP) and assessed the various postnatal factors that affect it. Lateral cephalograms of 140 subjects (mean (SD) aged 7 (2) years) with UCLP were taken before orthodontic treatment. Surgeons from Hokkaido University Hospital had done the primary operations. The craniofacial morphology was assessed by angular and linear cephalometric measurements. Cheiloplasty, palatoplasty, and preoperative orthopaedic treatment were chosen as postnatal factors. To compare the assessments of the postnatal factors, we made angular and linear cephalometric measurements for each subject and converted them into Z scores in relation to the mean (SD) of the two variables. Subjects treated by the modified Millard cheiloplasty had larger sella-nasion-point A (SNA) and nasion-point A-pogonion (NA-POG) measurements than subjects treated by the modified Millard with a vomer flap cheiloplasty. Two-stage palatoplasty showed consistently better craniofacial morphology than the other palatoplasty. Subjects who had preoperative orthopaedic treatment with a Hotz plate had significantly larger upper incisor/sella-nasion (U1-SN) measurements than who had no preoperative orthopaedic treatment or an active plate. We conclude that in subjects treated by a modified Millard type of cheiloplasty, a two-stage palatoplasty, and a Hotz plate there were fewer adverse effects on craniofacial morphology.     

大年龄未手术腭裂患者上颌牙弓形态发育的研究

目的：探讨影响上颌牙弓生长发育的因素。方法：对２０例未手术腭裂患者的牙颌模型进行测量,并与２０名正常成人作对照分析。结果：大年龄未手术腭裂患者与正常成人在尖牙区宽度存在显著性差异（Ｐ〈０．０５）。而上颌深度及后牙区的宽度无显著性差异（Ｐ〉０．０５）。结论：在腭裂组,畸形的存在主要是在切牙区及尖牙区,对后牙区横向和垂直向的影响较小。     

双侧完全性唇腭裂新生儿进行鼻-齿槽塑形治疗的临床研究

目的观察鼻-齿槽塑形治疗(presurgical nasal-alveolar molding,PNAM)对双侧完全性唇腭裂婴儿的临床疗效。方法对20例出生10天~3个月的双侧完全性唇腭裂新生儿进行鼻-齿槽的整形,测量治疗前后的双侧上唇裂隙宽度、前鼻突到唇裂距离、鼻小柱长度及唇裂交角,并用SPSS21.0软件进行统计分析。结果经过3~4个月的PNAM治疗后,双侧上唇裂隙宽度、前鼻突到唇裂距离明显减小,鼻小柱长度明显增加,均有统计学意义;唇裂交角增大,但无统计学意义。鼻外形左右基本对称,鼻翼外形恢复不明显,鼻小柱位于面部正中位置。结论 PNAM塑形治疗能有效减少双侧完全性唇腭裂婴儿的上唇裂隙宽度,压低前鼻突,伸长鼻小柱,改善鼻外观,降低手术难度。     

Special distraction osteogenesis before bone grafting for alveolar cleft defects to correct maxillary deformities in patients with bilateral cleft lips and palates: Distraction osteogenesis performed separately for each bone segment

IntroductionPatients with bilateral cleft lips and palates have premaxillary protrusion and characteristic jaw deformities involving three-dimensional malposition of the premaxilla and bilateral maxillary bone segments. This study examined patients with bilateral cleft lips and palates who had deviation and hypoplasia of the premaxillas and bilateral maxillary segments. Before bone grafting, the patients were treated with special distraction performed separately for each bone segment using a halo-type external device. This report describes this novel treatment method which produced good results.Material and methodsThe subjects were five patients with severe jaw deformities due to bilateral cleft lip and palate. They were treated with maxillary Le Fort I osteotomy and subsequent distraction performed separately for each bone segment using a halo device. In three of five patients, premaxillary osteotomy was not performed, and osteotomy and distraction were performed only for the right and left lateral segments with severe hypoplasia.ResultsAll patients achieved distraction close to the desired amount. The widths of the alveolar clefts were narrowed, and satisfactory occlusion and maxillary arch form were achieved. After the surgery, three of five patients underwent bone grafting for bilateral alveolar cleft defects and the bone graft survival was satisfactory.ConclusionsThis method had many benefits, including narrowing of alveolar clefts, improvement of maxillary hypoplasia, and achievement of a good maxillary arch form. In addition, subsequent bone grafting for alveolar cleft defects was beneficial, dental prostheses were unnecessary, and frequency of surgery and surgical invasiveness were reduced. This method is a good surgical procedure that should be considered for patients with bilateral cleft lips and palates who have premaxillary protrusion and hypoplasia of the right and left lateral segments.     

腭裂硬腭后缘裂隙宽度与上颌结节后缘平面宽度比例变化规律的研究

目的 通过研究单纯性腭裂患者硬腭后缘裂隙宽度与上颌结节后缘平面宽度的比例的增龄性变化,了解患者的腭裂畸形程度和生长发育之间的关联性。方法 应用回顾性研究的方法选取581例单纯性腭裂患者,年龄为8个月至38岁,根据术前测量时的年龄段共分为7组。在患者术前采用直接测量法所获得的各项测量数据中,选取上颌结节后缘平面宽度和硬腭裂隙宽度两项,以每位患者的硬腭裂隙宽度除以上颌结节后缘平面宽度的比值（即腭裂指数）来分析腭裂裂隙的相对宽度。结果 随着患者年龄增长,腭裂裂隙在上颌所占横向比例增大,即腭裂的畸形程度随患者年龄增长呈现上升趋势。结论 本研究证实了单纯性腭裂患者腭裂裂隙宽度和上颌结节后缘平面宽度与患者年龄增长存在关联性,腭裂的严重程度和手术难度会随着患者的年龄增长而逐步加重。     

Simplifying cleft surgery by presurgical nasoalveolar molding (PNAM) for infant born with unilateral cleft lip,alveolus, and palate: A clinical report

PatientA 2-day-old female infant with complete unilateral cleft lip, alveolus, and palate (left side) was presented to the Department of Prosthodontics, Government Dental College and Hospital, Nagpur for evaluation and treatment with presurgical nasoalveolar molding (PNAM) prior to surgical intervention.DiscussionThe alignment of the alveolar segments creates the foundation upon which excellent results of primary lip and nasal surgery are dependent in the repair of the cleft lip, alveolus, and palate patient. Presurgical infant orthopedics has been employed since the 1950s as an adjunctive neonatal therapy for the correction of cleft lip and palate. One of the problems that the traditional approach failed to address was the deformity of the nasal cartilages and the deficiency of columella tissue in infants with unilateral and bilateral cleft lip and palate. The purpose of this article is to illustrate the step-by-step fabrication process of the PNAM prosthesis used to direct growth of the alveolar segments, lips, and nose in the presurgical treatment of cleft lip and palate.ConclusionAs a result, the primary surgical repair of the lip and nose heals under minimal tension, thereby reducing scar formation and improving the esthetic result. Frequent surgical intervention to achieve the desired esthetic results can be avoided by PNAM.     

Canine eruption into grafted alveolar clefts: a retrospective study

BACKGROUND: The contemporary treatment of cleft lip and palate involves a sequence of surgical procedures and orthodontic management. Alveolar bone grafting (ABG) is usually undertaken after orthodontic expansion of the maxillary segments between the ages of eight and 12 years. Two of the important goals of alveolar bone grafting are the provision of bony support for the eruption of the canine and the closure of residual oro-nasal fistulae. The purpose of this study was to retrospectively evaluate the root development and eruption of the canine following ABG. METHODS: Group 1: radiographic and clinical records of a sample of 19 cleft patients who underwent alveolar bone grafting procedures, performed between 1996 and 1999 were reviewed. Group 2: a random sample of 15 cleft patients attending for routine dental review were clinically examined. The age of patient, degree of root development and eruption status of the canine, and presence of oronasal fistulae pre and post alveolar bone grafting were evaluated. RESULTS: Most cleft canines had continued root development and descended in the alveolus towards eruption following ABG. Four canine teeth (8 per cent) were impacted and required surgical exposure and orthodontic treatment following failure of eruption. Closure of anterior oro-nasal fistulae at the time of grafting was maintained post-operatively. CONCLUSIONS: This study demonstrated that canine root development and eruption continued satisfactorily through grafted alveolar clefts in most cases and closure of anterior oro-nasal fistulae was achieved in all cases.     

单侧完全性唇腭裂新生儿上颌牙槽形态的三维测量分析

目的 研究非综合征型单侧完全性唇腭裂新生儿上颌牙槽的三维形态特征,并验证三维测量方法的可靠性及可重复性。方法 筛选60名单侧完全性唇腭裂新生儿,通过iTero口内扫描仪对其初始上颌石膏模型进行扫描,由同一研究员使用Mimics软件对上颌牙槽的25个测量项目进行共两次三维测量,对两次的测量结果进行Bland-Altman一致性检验;并依据上颌牙槽的形态将样本分为G1、G2、G3三组,通过两两比较研究不同分组上颌牙槽的形态差异。结果 所有测量值的结果均符合正态分布,且两次测量结果具有较好的一致性。单侧完全性唇腭裂新生儿健侧的前段牙槽长度以及前后段牙槽的旋转角均明显大于对侧的前后段牙槽;G1及G2组健侧前段牙槽长度明显长于G3组,G1组牙槽裂隙宽度、牙弓中段的裂隙宽度、尖牙水平的牙弓宽度和健侧前段牙槽的旋转角都明显小于G2、G3组。结论 本研究统计了非综合征型单侧完全性唇腭裂新生儿上颌牙槽的平均尺寸,前段牙槽的发育不足和健侧前段牙槽的外旋程度共同决定了单侧唇腭裂牙槽裂隙的严重程度。     

The effects of palatoplasty and pre-surgical infant orthopedic treatment on occlusion in unilateral cleft lip and palate patients

PurposeThe aim of this study was to evaluate the effect of pre-surgical infant orthopedic treatment (Hotz plate) and type of palatoplasty on the dental arch relationship and the dental arch morphology of unilateral cleft lip and palate (UCLP) patients.Materials and methodsSeventy-four children with UCLP were divided into three groups. One group had undergone one-stage palatoplasty without Hotz plate (OSP w/o H), the second had undergone one-stage palatoplasty with Hotz plate (OSP w/H), and the third had undergone two-stage palatoplasty with Hotz plate (TSP w/H). We evaluated the dental models which were taken during initial examination at our orthodontic clinic, using the Goslon Yardstick, the 5-year-old index, and dental model analysis.ResultsRegarding both indices, there were no significant differences among the three groups. However, the dental arch width between maxillary deciduous canines in OSP w/H and TSP w/H was significantly greater than that of OSP w/o H. The dental arch width at the maxillary deciduous second molars in TSP w/H was significantly greater than in OSP w/H and OSP w/o H.ConclusionDental arch relationship in UCLP patients was not influenced by the type of palatoplasty and the use of pre-surgical infant orthopedic treatment. Our results suggest that pre-surgical infant orthopedic treatment results in the increase of anterior dental width, whereas two-stage palatoplasty is significantly effective for increasing posterior dental width in UCLP patients.     

单侧完全性唇腭裂患儿鼻牙槽塑形术后3年临床效果分析

目的    通过对单侧完全性唇腭裂患儿鼻牙槽塑形（PNAM）治疗前及术后3年鼻部对称性的测量,分析PNAM治疗术后3年的临床效果。方法    选择2011年2月至2011年6月于西安交通大学附属口腔医院进行PNAM治疗的15例单侧完全性唇腭裂患儿,从PNAM治疗前至治疗后3年分为4个时间点：初次就诊（T0）、PNAM治疗结束（T1）、唇裂修复术后（T2）和治疗后3年（T3）;拍摄正位和仰90°面部照片,在照片中标记12个鼻部标志点,进行16项测量。结果    与T0进行相比,T1鼻背倾斜度和鼻小柱倾斜度明显减小（均P＜0.05）;与T1相比,T2鼻背倾斜度、鼻小柱倾斜度、患侧与健侧鼻翼高度比、患侧与健侧鼻底高度比、鼻底与内眦连线比均明显减小（均P＜0.05）,患侧鼻翼顶与鼻底高度比明显增大（均P＜0.05）;与T2相比,T3鼻小柱倾斜度有复发,其余测量指标差异均无统计学意义（均P＞0.05）。结论    PNAM治疗可明显改善患儿鼻部对称性,鼻部形态在术后3年仍保持稳定。     

完全性唇腭裂婴儿术前正畸治疗的临床研究

目的 观察术前鼻-牙槽突矫治器(PNAM)在完全性唇腭裂婴儿术前矫治中的作用.方法 采用术前鼻-牙槽突矫治器对45例非综合征性完全性唇腭裂患儿(平均年龄为18.33 d)进行唇裂术前正畸治疗,测量治疗前后的鼻小柱倾斜度、鼻小柱长度、鼻孔宽度、鼻孔高度和牙槽骨裂隙宽度,并用SPSS 10.0软件进行统计分析.结果 经PN...     

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??Objective    To evaluate the three-year clinical effect of presurgical nasoalveolar molding in unilateral complete cleft lip and palate??UCLP??. The nasal symmetry was accessed before and 3 years after PNAM. Methods    Fifteen UCLP infants were included. There were 4 time points?? before and after PNAM??T0 and T1????after primary cheiloplasty and 3 years after treatment ??T2 and T3??. Photos were taken??12 markers and 16 measurements were selected to access nasal symmetry. The measurements were columellar deviation??nasal bridge deviation??alanasi height?? base nasiheight??ratio of the height of the alanasi and base nasi in healthy and affected side?? the width and height of nostril in healthy and affected side??gradient of columella nasi??the ratio of the width and the height of nostril in both sides. Results    Compared to T0??columellar deviation and nasal bridge deviation at T1 were significantly decreased??P??0.05???? compared to T1??columellar deviation??nasal bridge deviation??the alanasi height??base nasi height in healthy and affected side and the ratio of the distance of endocanthion and base nasi at T2 were significantly decreased??P??0.05????while ratio of the height of the alanasi and base nasi was significantly increased??P??0.05??. Compared to T2 the measurements didn't have significant change at T3??P > 0.05??. Conclusion    PNAM and primary cheiloplasty will reconstruct the nasal morphology that can be maintained after three years.     

婴儿期单侧完全性唇腭裂术前颌骨矫治器的应用

目的：为了提高唇裂修复的效果，在16例婴儿期完全性唇腭裂术前采用Latham颌骨矫治器，关闭婴儿单侧唇腭裂的牙槽嵴裂隙，为唇鼻整形奠定基础。方法：采用Latham颌骨矫治器方法，个体化制作矫制器，用骨内针固定矫治器。用螺旋式加力法将错位的各骨段移位到较为理想的排列位置。结果：经过2～4周矫治后可使患侧鼻翼基底部升高，两侧牙槽嵴裂隙显著缩小。结论：对婴儿期完全性唇腭裂术前颌骨裂隙的矫治，为初期的整形手术奠定了较好基础。     

鼻牙槽嵴塑形矫治器在单侧完全性唇腭裂腭部畸形矫治中的效果评价

目的 评价鼻牙槽嵴塑形（PNAM）矫治器对单侧完全性唇腭裂患者腭部畸形的矫治效果。方法 研究对象分为3组,每组19例。A、B组均为非综合征单侧完全性唇腭裂患者,A组在唇腭裂手术前先行PNAM矫治,B组术前未行PNAM矫治。C组为3月龄左右鼻唇部及腭部发育正常婴儿。获取A组PNAM矫治前及PNAM矫治后唇裂术前、B组唇裂术前和C组的标准腭部模型正位照片,对模型照片进行测量。采用SPSS 21.0软件进行分析。结果 A组PNAM矫治后与矫治前相比,患者的牙弓宽度（AW）、牙弓周长（AC）、腭部面积（PA）明显增加（P<0.05）,腭部裂隙宽度（CPW）、牙槽突裂隙宽度（CWA）、牙槽突裂隙矢状向距离（CWAS）与水平向距离（CWAH）、前颌突倾斜度（PMD）、裂隙面积（CA）明显减小（P<0.05）;但与C组相比仍有差距（P<0.05）;B组AW、CPW、CA及PA较A组矫治前均明显增加（P<0.05）。多元方差分析表明,3组上颌结节间距离（TW）均无统计学差异（P>0.05）。结论 PNAM矫治是早期有效改善患者腭部原发畸形的非手术治疗手段之一。     

Sagittal growth of the facial skeleton of 6-year-old children with a complete unilateral cleft of lip, alveolus and palate treated with two different protocols

OBJECTIVE: The purpose of the study was to compare sagittal growth of the facial skeleton of 6-year-old children treated in two cleft centres with different surgical protocols. MATERIAL AND METHODS: Each group consisted of 20 consecutive non-syndromic children with complete unilateral cleft lip, alveolus and palate. They all had presurgical orthopaedics with a passive plate and external strapping until lip repair. Centre 1 had lip repair at the age of 3 months and one stage palatal closure at the age of 1 year. Closure of the alveolar cleft was planned at 9 years with bone grafting. In centre 2 lip repair was performed at the age of 6 months, soft palate repair at 12 months and hard palate repair together with mucoperiosteal closure of the alveolar cleft at the age of 30 months. At the time of investigation, the children from both centres had not received any postoperative orthodontic treatment. Sagittal growth was evaluated on lateral cephalograms using the angles SNA, SNB, ANB and SNPg. For control, Droschl standards were used. The Mann-Whitney U test was used for statistical analysis. RESULTS: There was no statistically significant difference in SNA, SNB, ANB and SNPg between the centres at the age of 6 years. There were no children with a class III jaw relationship. The sagittal dimensions were close to the values of non-cleft control persons (Droschl standards). CONCLUSION: There was considerable similar sagittal growth of the facial skeleton in both centres which has not been affected by the different surgical protocols so far. A final evaluation should be delayed until the growth of the facial skeleton is complete.     

Skeletal,dental and facial aesthetic changes following anterior maxillary segmental distraction by tooth-borne device in patients with cleft lip and palate

Maxillary skeletal deficiency secondary to cleft lip and palate (CLP) remains a significant challenge. The aim of this study was to present the comprehensive skeletal, dental and facial aesthetic outcomes of anterior maxillary segmental distraction osteogenesis (AMSDO) for treatment of maxillary hypoplasia in patients with CLP. Twelve patients with maxillary hypoplasia treated with AMSDO by a customized tooth-borne distractor were included. Three-dimensional changes of anterior maxillary segment, upper incisor and pharyngeal space were measured by three-dimensional reconstruction derived from cone beam computed tomography (CBCT) data. Length and width of dental arch during distraction were determined in dental casts. Nasolabial angle, soft-tissue convexity and patient’s subjective satisfaction were assessed to evaluate facial aesthetic improvements. Nasopharyngoscopic evaluation and speech assessment were also performed before and after distraction. All patients successfully received AMSDO without serious complications. Following AMSDO, the anterior maxillary segments moved forward 5.56 ± 0.28 mm and slightly upward 1.15 ± 0.13 mm. AMSDO significantly lengthened maxillary dental arch, generated new bone to relieve dental crowding and improved patients’ facial aesthetic without worsening velopharyngeal closure and speech quality. AMSDO by tooth-borne distractor is an effective surgical alternative for the advancement in patients with cleft maxillary hypoplasia.