International Journal of Dental Sciences and Research
ISSN (Print): 2333-1135 ISSN (Online): 2333-1259 Website: Editor-in-chief: Marcos Roberto Tovani Palone
Open Access
Journal Browser
International Journal of Dental Sciences and Research. 2022, 10(1), 4-7
DOI: 10.12691/ijdsr-10-1-2
Open AccessReview Article

Different Treatment Modalities of Maxillary Protraction in Cleft Lip and Palate Patients: A Literature Review

Ghada Alaglan1,

1Faculty Member at Orthodontic and Pediatric Dentistry Department, Qassim University, Buraidah City, Saudi Arabia

Pub. Date: May 12, 2022

Cite this paper:
Ghada Alaglan. Different Treatment Modalities of Maxillary Protraction in Cleft Lip and Palate Patients: A Literature Review. International Journal of Dental Sciences and Research. 2022; 10(1):4-7. doi: 10.12691/ijdsr-10-1-2


Cleft lip and palate is the most common cranio-facial defect with patients displaying unfavorable growth pattern of the cranio-facial complex. When such a deficiency in growing subjects, is left untreated, can lead to severe functional, aesthetic, breathing and psychological problems. To treat patients with cleft lip and palate, early orthopedic correction is considered to be advantageous. This can be applied through a tooth-anchored protraction facemask, bone-anchored protraction facemask or even the application of direct force via intra-oral inter-maxillary elastics anchored in mini-plates between the maxilla and the mandible.

maxillary protraction cleft lip cleft palate class iii malocclusion bone anchored facemask

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit


[1]  Mossey, P.A, Modell, B., “Epidemiology of oral clefts 2012: an international perspective,” Front Oral Biol, 16: 1-18. 2012.
[2]  Yu, W., Serrano, M., Miguel, S.S., Ruest, L.B., Svoboda, K.K., “Cleft lip and palate genetics and application in early embryological development,” Indian Journal of Plastic Surgery, 42: 35-50. 2009.
[3]  Worley, M.L, Patel, K.G., Kilpatrick, L.A., “Cleft Lip and Palate,” Clin Perinatol, 45(4): 661-678. 2018.
[4]  Wong, F.K., Hagg, U., “An update on the aetiology of orofacial clefts,” Hong Kong Med J, 10(5): 331-336. 2004.
[5]  Dixon, M.J., Marazita, M.L., Beaty, T.H., Murray, J.C., “Cleft lip and palate: understanding genetic and environmental influences,” Nat Rev Genet. 12(3): 167-178. 2011.
[6]  Burg, M.L., Chai, Y., Yao, C.A., Magee, W., Figueiredo J.C., “Epidemiology, Etiology, and Treatment of Isolated Cleft Palate,” Front Physiol, 7: 67. 2016.
[7]  Palikaraki, G., Makrygiannakis, M.A., Zafeiriadis, A.A., et al., “The effect of facemask in patients with unilateral cleft lip and palate: a systematic review and meta-analysis,” Eur J Orthod, 43(1): 69-79. 2021.
[8]  Yatabe, M., Garib, D.G., Faco, R.A.S., et al., “Bone-anchored maxillary protraction therapy in patients with unilateral complete cleft lip and palate: 3-dimensional assessment of maxillary effects.,” Am J Orthod Dentofacial Orthop, 152(3): 327-335. 2017.
[9]  Capelozza Filho, L., Normando, A.D., da Silva Filho, O.G., “Isolated influences of lip and palate surgery on facial growth: comparison of operated and unoperated male adults with UCLP,” Cleft Palate Craniofac J, 33(1): 51-56. 1996.
[10]  Liao, Y.F., Mars, M., “Hard palate repair timing and facial growth in cleft lip and palate: a systematic review,” Cleft Palate Craniofac J, 43(5): 563-570. 2006.
[11]  Liao, Y.F., Mars, M., “Long-term effects of clefts on craniofacial morphology in patients with unilateral cleft lip and palate,” Cleft Palate Craniofac J, 42(6): 601-609. 2005.
[12]  Semb, G., “A study of facial growth in patients with unilateral cleft lip and palate treated by the Oslo CLP Team,” Cleft Palate Craniofac J, 28: 1-21. 1991.
[13]  Steegman, R.M., Klein Meulekamp, A.F., Dieters, A., Jansma, J., van der Meer, W.J., Ren, Y., “Skeletal Changes in Growing Cleft Patients with Class III Malocclusion Treated with Bone Anchored Maxillary Protraction-A 3.5-Year Follow-Up,” J Clin Med, 10(4): 750. 2021.
[14]  Delaire, J., Verdon, P., Kenesi, M.C., “Extraorale Zugkraften mit Stirn-Kinn-Abstutzung zur Behandlung der Oberkieferdeformierungen als Folge von Lippen-Kiefer-Gaumenspalten,” Journal of Orofacial Orthopedics, 34: 225-237. 1973.
[15]  Tindlund, R.S., Rygh, P., “Maxillary protraction: different effects on facial morphology in unilateral and bilateral cleft lip and palate patients,” Cleft Palate Craniofac J, 30(2): 208-221. 1993.
[16]  Toffol, L.D., Pavoni, C., Baccetti, T., Franchi, L., Cozza, P., “Orthopedic treatment outcomes in Class III malocclusion. A systematic review,” Angle Orthod, 78(3): 561-573. 2008.
[17]  De Clerck, H.J., Cornelis, M.A., Cevidanes, L.H., Heymann, G.C., Tulloch, C.J., “Orthopedic traction of the maxilla with miniplates: a new perspective for treatment of midface deficiency,” J Oral Maxillofac Surg. 67(10): 2123-2129. 2009.
[18]  Keçik, D., “Evaluation of Protraction Face-Mask Therapy on the Craniofacial and Upper Airway Morphology in Unilateral Cleft Lip and Palate,” J Craniofac Surg. 28(7): e627-e632. 2017.
[19]  Singla, S., Utreja, A., Singh, S.P., Suri, S., “Maxillary protraction by reverse headgear treatment in patients with unilateral cleft lip and palate: a cephalometric evaluation,” Journal of Cleft Lip and Palate Craniofacial Anomalies, 5: 32-39. 2018.
[20]  Zhang, Y., Jia, H., Fu, Z., et al., Dentoskeletal effects of facemask therapy in skeletal Class III cleft patients with or without bone graft, Am J Orthod Dentofacial Orthop, 153(4): 542-549. 2018.
[21]  Dogan, S., “The effects of face mask therapy in cleft lip and palate patients,” Ann Maxillofac Surg, 2(2): 116-20. 2012.
[22]  Westwood, P.V., McNamara, J.A. Jr., Baccetti, T., Franchi, L., Sarver, D.M., “Long-term effects of Class III treatment with rapid maxillary expansion and facemask therapy followed by fixed appliances,” Am J Orthod Dentofacial Orthop, 123: 306-20. 2003.
[23]  Baccetti, T., Reyes, B.C., McNamara, J.A.Jr., “Craniofacial changes in Class III malocclusion as related to skeletal and dental maturation,” Am J Orthod Dentofacial Orthop, 132: 171. e1-12. 2007.
[24]  Yepes, E., Quintero, P., Rueda, Z.V., Pedroza, A., “Optimal force for maxillary protraction facemask therapy in the early treatment of class III malocclusion,” Eur J Orthod, 36(5): 586-594. 2014.
[25]  Ren, Y., Steegman, R., Dieters, A., Jansma, J., Stamatakis, H., “Bone-anchored maxillary protraction in patients with unilateral complete cleft lip and palate and Class III malocclusion,” Clin Oral Investig, 23(5): 2429-2441. 2019.
[26]  Mandall, N., Cousley, R., DiBiase, A., et al., “Early class III protraction facemask treatment reduces the need for orthognathic surgery: a multi-centre, two-arm parallel randomized, controlled trial,” J Orthod, 43(3): 164-175. 2016.
[27]  Ngan, P., Wilmes, B., Drescher, D., Martin, C., Weaver, B., Gunel, E., “Comparison of two maxillary protraction protocols: tooth-borne versus bone-anchored protraction facemask treatment,” Prog Orthod, 16: 26. 2015.
[28]  Meazzini, M.C., Zappia, L.B., Tortora, C., Autelitano, L., Tintinelli, R., “Short- and Long-Term Effects of Late Maxillary Advancement With the Liou-Alt-RAMEC Protocol in Unilateral Cleft Lip and Palate.” Cleft Palate Craniofac J, 56(2):159-167. 2019.
[29]  Liou, E.J., Tsai, W.C., “A new protocol for maxillary protraction in cleft patients: repetitive weekly protocol of alternate rapid maxillary expansions and constrictions,” Cleft Palate Craniofac J, 42(2): 121-127. 2005.
[30]  Singh, S., Batra, P., Raghavan, S., Sharma, K., Srivastava, A., “Evaluation of Alt-RAMEC With Facemask in Patients With Unilateral Cleft lip and Palate (UCLP) Using Cone Beam Computed Tomography (CBCT) and Finite Element Modeling-A Clinical Prospective Study.” Cleft Palate Craniofac J, 59(2): 166-176. 2022.
[31]  Garib, D., Yatabe, M., de Souza Faco, R.A., Gregório, L., Cevidanes, L., de Clerck, H., “Bone-anchored maxillary protraction in a patient with complete cleft lip and palate: A case report,” Am J Orthod Dentofacial Orthop, 153(2): 290-297. 2018.
[32]  Faco, R., Yatabe, M., Cevidanes, L.H.S., Timmerman, H., De Clerck, H.J., Garib, D., “Bone-anchored maxillary protraction in unilateral cleft lip and palate: a cephalometric appraisal,” Eur J Orthod, 41(5): 537-543. 2019.
[33]  Baek, S.H., Kim, K.W., Choi, J.Y., “New treatment modality for maxillary hypoplasia in cleft patients. Protraction facemask with miniplate anchorage,” Angle Orthod, 80(4): 783-91. 2010.
[34]  Angelieri, F., Franchi, L., Cevidanes, L.H.S., Hino, C.T., Nguyen, T., McNamara, J.A. Jr., “Zygomaticomaxillary suture maturation: A predictor of maxillary protraction? Part I - A classification method,” Orthod Craniofac Res, 20(2): 85-94. 2017.
[35]  Nguyen, T., Cevidanes, L., Paniagua, B., Zhu, H., Koerich, L., De Clerck, H., “Use of shape correspondence analysis to quantify skeletal changes associated with bone-anchored Class III correction,” Angle Orthod, 84: 329-36. 2014.
[36]  Angelieri, F., Ruellas, A.C., Yatabe, M.S., et al., “Zygomaticomaxillary suture maturation: Part II-The influence of sutural maturation on the response to maxillary protraction,” Orthod Craniofac Res, 20(3): 152-163. 2017.