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Hyrax Application as a Tooth-Borne Distractor for Maxillary Advancement

Showkatbakhsh, Rahman DDS*; Pourdanesh, Fereydoun DDS; Jamilian, Abdolreza DDS; Ghorbani, Abolfazl DDS; Behnaz, Mohammad DDS*

Journal of Craniofacial Surgery: July 2011 - Volume 22 - Issue 4 - p 1361-1366
doi: 10.1097/SCS.0b013e31821c93d8
Clinical Studies

Distraction osteogenesis (DO) has become a mainstream surgical technique for patients with jaw deformities. The aim of this study was to report the use of internal DO in the treatment of maxillary hypoplasia in a patient with cleft lip and palate.

The case illustrates a 17-year-old boy with class III malocclusion, maxillary deficiency, and cleft lip and palate. Because the patient was experiencing severe hypernasality, it was decided to treat him by DO. The treatment process began by mounting a hyrax in the upper jaw for lateral expansion. A second hyrax was mounted in a way to create anteroposterior expansion. One day after the second hyrax application, the patient underwent a modified Le Fort I osteotomy. He was instructed to turn the screws twice per day for 12 days. The treatment was continued by means of a conventional face mask for 2 months. After 16 months of active treatment, favorable correction of the skeletal problem was observed. The S-N-A angle increased by 5 degrees, and patient's hypernasality was comprehensively improved.

From the Departments of *Orthodontics and †Oromaxillofacial Surgery, Shahid Beheshti University of Medical Sciences; and ‡Department of Orthodontics, School of Dentistry, Islamic Azad University, Tehran, Iran.

Received June 5, 2010.

Accepted for publication November 14, 2010.

Address correspondence and reprint requests to Abdolreza Jamilian, DDS, No 2713, Vali Asr St, Tehran 1966843133, Iran; E-mail:

The authors report no conflicts of interest.

© 2011 Mutaz B. Habal, MD