Patient with cleft lip and bilateral cleft palate. The premaxilla was protruded and rotated to the right, and the lateral segments had collapsed. This protrusion made lip surgery difficult because it increased soft tissue tension.

After impression taking, an ECPR was designed and placed under general anaesthesia. The parents activated the appliance at home to achieve the expansion and once a week we modified the tension of the chains to achieve the retrusion of the premaxilla.

After six weeks the premaxilla had retracted and the segments were aligned so that cheiloplasty with the Mulliken technique could be performed.

