Statement of the problem: Maxillary 3-D deficiency is a common finding in patients treated after cleft lip and palate. Performing maxillary advancement, expansion, inferior repositioning and alveolar grafting; is usually done in stages.

The aim of this study was to evaluate the outcomes after combining these procedures in one stage, modifying Cheung’s protocol.

Materials and methods: Six patients 3M/3F, ages 13–32 y.o. (ave. 23.7) underwent maxillary 3-D repositioning, fixing the segments to a palatal splint, a 2 mm chain plate was used with multiple screws above the teeth to stabilize the different segments and advancement intraoral distractors were anchoraged to the zygomas; also, alveolar cleft bone grafts with soft tissue management were inserted. A latency period of 7 days, activation of 1 mm a day and consolidation phase of 6 months protocol was used.

Results: Four patients were unilateral clefts and 2 bilateral. The maxilla was advanced an average of 9 mm (6–14), inferiorly repositioned 3.5 mm (0–5), and widened 5 mm (0–7).

The anterior vertical maxillary movement was controlled with a circumferential anterior wire around the nasal bones fixed to the acrylic splint. All movements were carefully planned out of the pre-surgical records and executed meticulously.

The splint and distractors were removed 6 months later (4–9 months post-op) to ensure bone healing and stability to remove the hardware.

Conclusions: All patients improved their esthetics and function dramatically in a stable and predictable manner.

Conflict of interest : Synthes consultor.