Figure 1.

Severe maxillary constriction in a 6-year-old boy affected by Crouzon-preoperative situation (a) selection of an appropriate device according to the individual plaster cast (b) intraoperative situation after insertion of the Surgitec device in May 2011 for the first distraction (c) intraoperative situation during the second distraction 3 months later, the same device is positioned more anterior in order to create additional alveolar crest (d) comparison of plaster casts before and after two stage transpalatal distraction (TPD) (e) panoramic X-rays before (f) and 12 months after (g) TPD demonstrating maxillary expansion–clinical follow up 36 months after pediatric TPD with stable skeletal situations (h and i) additional widening might be required