Introduction: severe maxillary deficiency of cleft lip and palate patients with traditional orthognathic correction may result in undercorrection, relapse or increased revisionary procedures. To see if Le Fort I internal distraction osteogenesis offers improved results, we compared this technique to traditional orthognathic treatment using serial evaluations and radiographs. Methods: Nonsyndromic cleft patients with severe maxillary deficiency (10mm) and normal mandibular growth were divided into 2 equal management groups: 1) Traditional Le Fort I advancement and 2) Le Fort I internal distraction (n=40). Preoperative, postoperative, and follow-up (mean 3.5 years) evaluations were based on dental casts, photographs, cephalograms and speech evaluations (Pittsburgh speech score, <3-5 was equivalent to velopharyngeal insufficiency (VPI). Results: Patients with severe maxillary deficiency and Le Fort I advancement (Group 1) had the following (means): SNA preop=75.7^o, postop=81.2^o and follow-up=78.8^o; preoperative to follow-up FH-x-axis (horizontal) change was 8.4mm; FH-y-axis (vertical) change was –1.3mm; 38% (5/13) had a follow-up class I occlusion, 8 needed readvancement; and 9 had VPI. Patients with severe maxillary deficiency and Le Fort I internal distraction (Group 2) had the following: SNA preop=74.2^o, postop=85.0^o and follow-up=84.2^o; preoperative to follow-up FH-x-axis (horizontal) change was 15.3mm; FH-y-axis (vertical) change was –1.0mm; 77% (10/13) had a follow-up class I occlusion, 4 needed reoperation; and 3 had VPI. For patients with severe maxillary deficiency, distraction cases showed an increase in SNA of 10.8^o compared to 5.5^o for traditional advancement. Horizontal advancement was 6.9mm greater to follow-up distraction cases compared to traditional cases. Conclusions: From these data we concluded, Le Fort I internal distraction for severe cleft maxillary deficiency leads to better dental occlusion, less relapse and better speech results. A follow-up study with quantitative serial speech evaluations (nasoendoscopy) is warranted.
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