Answer:
A severely protruding maxilla poses a difficult surgical problem by obstructing the cleft lip repair or placing undue tension on an overlying lip repair. McCarthy (p.2658) proposes the following five methods of repair in order of preference:
1. Traction of external cleft with head cap.
2. Closure of the clefts, one at a time.
3. Lip adhesion.
4. Intraoral elastic traction device
5. Surgical setback of the maxilla.