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In this chapter, we introduced three new orthodontic and orthopedic techniques and one surgical distraction osteogenesis for the management of maxillary deformities in growing unilateral and bilateral cleft patients. These techniques are the effective maxillary orthopedic protraction for correcting a hypoplastic maxilla and minimizing alveolar cleft, premaxillary orthopedic intrusion for correcting a downward displaced premaxilla, premaxillary orthopedic medial repositioning for correcting a lateral displaced premaxilla, and interdental distraction osteogenesis for approximating a wide alveolar cleft. These techniques utilize principles of distraction osteogenesis. The orthopedic approaches could be a form of sutural expansion or protraction osteogenesis, and their treatment effects are mostly orthopedic and partly orthodontic. The interdental distraction is a form of callus distraction osteogenesis. The clinical and radiographic evaluations have revealed their successful applications for solving maxillary deformities in growing cleft patients.

For the cleft patient presenting in adolescence with a jaw discrepancy and malocclusion, misinformation and limited available surgical and dental expertise often prevents a favorable facial reconstruction and dental rehabilitation. A major advantage of the modified Le Fort I osteotomy is its ability to simultaneously: close cleft dental gap(s), resolve oro-nasal fistulas, manage skeletal defects, stabilize dentoalveolar segments, and correct jaw deformities. When a thoughtful staging of reconstruction is undertaken, individuals born with cleft lip and palate can reach adolescence after undergoing only a limited number of operations and interventions, without negative attention being drawn to their original malformation.

With appropriate early grafting of the cleft palate child and stimulation of the graft orthodontically and orthopedically, later orthognathic surgical procedures can be avoided and the incidence of the relapse can be greatly diminished. If appropriate treatment protocols are followed, relapse and the loss of control of the premaxilla, deficiencies in growth of the premaxilla, and other functional impairments can be avoided. Additionally, the future appears to be very exciting in the area of developing improved methods of restoration and rehabilitation of the osseous cleft palate patient involving genetic engineering resulting in minimizing complications and long-term relapse.

Several instrumental procedures are available for assessing the velopharyngeal mechanism and its function. Each has advantages and disadvantages, and choosing among them depends on the specific purpose of the evaluation. The reliability of endoscopic procedures is not well documented. Aerodynamic measures provide data about the area of the velopharyngeal opening, velopharyngeal resistance to air flow, and air pressure available for the production of obstruent sounds. These measures provide no information about the relative contributions of the velum and the pharyngeal walls to velopharyngeal function. An important warning in the use of any instrumentation for the study of speech is that data taken during speech production must be interpreted within the context of the patient’s repertoire of speech proficiency.