Bone Anchored Maxillary Protraction: Outcomes, Complications, And Implications For Future Orthognathic Surgery In Patients With Cleft Lip And Palate

PURPOSE: Maxillary hypoplasia is a common finding in patients with cleft lip and palate (CLP) and often requires maxillary advancement via a LeFort I osteotomy at the time of skeletal maturity. Bone anchored maxillary protraction (BAMP) has been used during adolescence to aid in maxillary growth and prevent worsening of a Class III malocclusion to avoid the need for orthognathic surgery. The purpose of this study was to evaluate the treatment outcomes of BAMP in patients with CLP, highlighting complications and revision rates and the need for future orthognathic surgery. METHODS: A retrospective chart review was conducted to identify patients with CLP who underwent BAMP placement at our institution over a 10-year period from 2015 to 2024. Patient demographics and surgical history were collected. The maxillomandibular relationship (i.e. overjet) as measured on physical examination pre- and post-BAMP treatment was recorded. Primary outcomes included duration of treatment, change in overjet over the course of treatment, complications rates, revision surgeries, and need for orthognathic surgery after treatment completion. RESULTS: Twenty-three patients with cleft palate (n=1), unilateral CLP (n=13) or bilateral CLP (n=8) underwent BAMP treatment for an average duration of 24.8 ± 14.1 months. Age at time of placement was 12.4 ± 1.0 years old. The Class III skeletal relationship was improved in 57% of patients with decrease in negative overjet post-treatment. There was no association between Veau classification or number of prior cleft-related surgeries and change in overjet. Complications were common. Eighteen patients (78.3%) experienced at least one complication. Hardware malfunction was seen in 16 patients (69.5%) with either loose, bent or broken plates and were more common in the maxilla compared to the mandible (75% vs 43%). Nine of these patients underwent a revision operation to adjust or replace at least one plate. Patient compliance was low. Thirteen patients (56.5%) reported wearing the dental elastics inconsistently. Out of the sixteen patients who completed treatment, twelve (75%) required orthognathic surgery and four (25%) did not. CONCLUSION: This study demonstrates high rates of complications and noncompliance with BAMP treatment with limited reduction in the requirement for LeFort I maxillary advancement in patients with CLP. Hardware complications often required revisions that increased the surgical burden of care. Indications for use should be reviewed.