Interim use of Hyrax Screw Assembly for Single-Step Closure of Small Alveolar Cleft before Anterior Maxillary Distraction Osteogenesis

Abstract

Anterior maxillary distraction osteogenesis (AMDO) is often used for correction of maxillary retrognathia in select cleft lip and palate cases. Restoration of alveolar arch continuity is desirable prior to initiation of AMDO in these cleft maxillary deformities. However, AMDO is technically difficult in a patient with coexisting alveolar cleft where there is a discontinuity of the defect that presents a challenge in terms of adequate vector control of movement of anterior segment and potential risk of tipping of teeth which already have compromised anchorage/bone support on the cleft side. Treatment process becomes further challenging when ongoing management is compounded by failed previous alveolar cleft grafting procedures along with the patient’s reluctance to undergo further grafting of alveolar clefts. Herein, we report a technical note demonstrating a novel application of the modification of the hyrax screw wherein an initially fully opened Hyrax screw was utilized as an interim assembly for accomplishing single-step closure of small alveolar cleft prior to commencement of anterior maxillary distraction osteogenesis. This technique may prove to be feasible for patients presenting with alveolar cleft defects of smaller widths of up to 5 mm and relatively well-aligned upper arches.
 Keywords: Alveolar Cleft; AMDO; Hyrax Screw; Single-Step Closure.