Aim: The midface or the maxilla in syndromatic patients as cleft lip and palate, crouzon or Apert syndrome can be severely retruded and hypoplastic in antero posterior and vertical dimension make difficult to correct in proper three-dimensional mode. In cleft lip and palate patients that need large advancement, the maxilla can be difficult to mobilize due to scarring from previous operations and there is a tendency to relapse after conventional orthognathic surgery. Based on research and clinical experience, distraction osteogenesis has minimal tendency to relapse even after great skeletal movements, due to the new bone formed in the distraction gap. In this presentation we will demonstrate our experience using internal and external devices in maxillary deficiency.

Material and methods: Maxillary distraction was performed using rigid extraoral devices and internal devices. The rate of distraction was 1 mm per day as was necessary to achieve Class I occlusion with slight overcorrection and to create facial profile convexity. Long term follow up will be presented.

Results: Our results demonstrate marked maxillary advancement using distraction osteogenesis methods with better stability over time and further maxillary growth when using the method also in growing patients. The profile of the face changed from concave to convex. The differences between internal and external devices will be presented.

Summary: Moderate to severe maxillary or midface deficiency is better treated by distraction osteogenesis then by conventional orthognathic surgery in special for younger patients with more severe deformities achieving greater advancement with less tendency to relapse over time.