In other patients whose arches are not well coordinated, and in patients who are very young, maxillary distraction with the RED is a very important intermediate procedure which allows the surgeon to obtain substantial maxillary advancement with good alignment of the basal skeleton between the upper and lower jaws. LeFort I procedure may be indicated at a later date to obtain final ideal occlusal relationships. However, the amount of vertical and horizontal change at the time of this definitive surgery should be minimal. This allows for total correction of the deficiency only in the affected jaw and the additional bone stock from the distraction procedure enables maximum stability and minimal chance for relapse. All of the supplies required to manufacture the appliance can be found in the orthodontist's office or laboratory.
Most orthodontists are familiar with the basic design of the appliance and how to manufacture it.
The day after surgery patients are placed on a soft diet and they gradually progress to a harder diet. The lip seal is not affected by the traction hooks therefore swallowing and speech are not impaired. Any time that the maxilla is advanced the risk exists of affecting the velopharyngeal mechanism. However, this effect is related to the amount of distraction performed. Patients with large anterior movements are more likely to experience velopharyngeal changes.