Non-Surgical Maxillary Protraction Using Delaire's Face-Mask in Cleft Affected Patients

Background: Vertical, horizontal and transverse hypoplasia of the maxilla is a common developmental problem in cleft lip and palate affected patients, which results in a midface deficiency, concave profile, constricted hard palate and skeletal Class III malocclusions. Objective: This study investigated the efficiency of maxillary protraction by means of Delaire's face mask after preliminary expansion using reverse quad helix in unilateral and bilateral cleft lip and palate affected patients at the deciduous and early mixed dentition stages prior to bone grafting. Method: Lateral cephalograms of 41 Israeli cleft lip and palate affected patients (17 boys and 24 girls) were evaluated at the beginning of treatment and at the end of active protraction. All patients had undergone preliminary surgical intervention to close the lip during the first 6 months of life and at approximately 18 months of age for palatal repair. The age of the patients when maxillary expansion and protraction commenced ranged between 5 to 12 years and continued for a mean duration of 38.23 months. Lateral cephalograms were used to analyze the achieved skeletal changes of the naso-maxillary complex during the treatment period. Results: Cephalometric tracings revealed an increase in facial height by 1.63 cm (p=0.009). The angle of convexity and the nasiolabial angle decreased by 1.18° and 5.07° (p=0.05 and p=0.034), respectively. Conclusion: The findings show that maxillary expansion followed by Delaire face mask therapy in cleft lip and palate patients is an efficient treatment method to improve sagittal skeletal dimensions of the nasomaxillary complex.