Device Fixation

Devices available for

left and right alveolar

clefts 15mm and 20mm.


Bilateral or unilateral wide alveolar cleft or

oronasal fistula in bilateral cleft lip and

palate patient.

Maxillary alveolar bony defect due to trauma.

Creating interdental edentulous space for

maxillary dental crowding.

Maxillary lengthening for maxillary hypoplasia

with or without dental crowding, and with or

without alveolar cleft.

Incision Closure

Device With

Distraction Complete

Developed in cooperation with Dr. Eric Liou

Chang Gung Memorial Hospital, Taipei, Taiwan

Consolidation Phase



Intra-Operative Approach

1. The lateral segments in bilateral cleft or lesser segment in unilateral cleft is usually the dental arch to be distracted.

However, it varies regarding different clinical situations of the cleft or defect. The site of interdental osteotomy is at

which the interdental osteotomy can be performed without damaging the dental roots. During osteotomy, care must be

taken to preserve 0.5-1 mm thickness of interdental alveolar bone adjacent to the dental roots. The widest interdental

alveolar bone usually is between the maxillary 1st molar and 2nd premolar. However, it varies regarding different clinical

situations of tooth alignment.

2. A horizontal intraoral incision is made along the buccal vestibule of the maxilla. Superior based mucoperiosteal

flaps are reflected, exposing the site of horizontal maxillary osteotomy on the buccal side. A vertical mucoperiosteal tunnel

extending upward from the interdental attached gingiva to the horizontal incision is made to expose the site of vertical

interdental osteotomy. Another small incision, on the palatal side, is made inside the gingival sulcus, exposing the

site of interdental osteotomy. Care must be taken to avoid reflecting or stripping all of the palatal mucosa.

3. By estimating on the radiographs or stereolithographic model, the anatomic position of the dental roots, sites of

interdental and horizontal maxillary osteotomies, and permanent tooth buds are marked on the alveolar bone with surgical

marking pens.

4. Complete horizontal osteotomy is performed with a cutting saw, 3 to 5 mm away from the dental root apex and

tooth buds. Complete interdental osteotomy is then performed with a small round bur and followed by a thin osteotome,

cutting through the buccal and palatal cortical plates respectively. As the cutting round bur encounters the cancellous

bone, the thin osteotome is then used for cutting carefully through the interdental cancellous bone buccolingually.

Before completing the interdental osteotomy, the distraction device is mounted on the proximal and distal segments

across the interdental osteotomy line. After the fixation of the device with bone screws, the interdental osteotomy is then

completed by the thin osteotome. Before closure of the wound, the device is tested by turning the screw forward completely

and then backward completely.

5. The incisions were irrigated and closed with absorbable suture.

6. Distraction protocol: A latency period of 5 days (younger patients) to 7 days (adult patients) is observed before

initiation of distraction osteogenesis. The distraction device is activated every day until both ends of the alveolar cleft or

oronasal fistula has been approximated. Rhythmic distraction is carried out at the rate of 0.9 mm/day (3 turns/day).

During interdental distraction, the distracted segment is allowed to move along the orthodontic arch wire in a curvalinear

direction. After completion of interdental distraction, the device was left in place for another 2 to 3 months before


7. Post-distraction orthodontic tooth movement: the orthodontic tooth movement into the distracted regenerate

(rapid orthodontic tooth movement) is initiated 2 to 3 weeks after completion of the distraction.

Devices Available

51-650-15 Liou Cleft Transport Distractor 15mm, Left

51-651-15 Liou Cleft Transport Distractor 15mm, Right

51-650-20 Liou Cleft Transport Distractor 20mm, Left

51-651-20 Liou Cleft Transport Distractor 20mm, Right

KLS-Martin L.P. P.O. Box 50249 • Jacksonville, FL 32250-0249

Phone 904-641-7746 • Toll Free 1-800-625-1557

Fax 904-641-7378 •

Distributed outside U.S.A. and Canada


P.O. Box 60 • D-78501 Tuttlingen - Germany

Telephone (0 74 61) 7 06 - 0 • Telefax (0 74 61) 7 06 193

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