Two approaches to the problem of contraction of the maxillary arch in pediatric patients, 4 to 12 years of age, with respiratory problems are discussed and compared. The results show that surgery and an orthopedic procedure, as opposed to orthopedic treatment alone, affords greater expansion of the maxilla and excellent stability. In addition, the use of a newly developed distractor enables a better result, both in terms of transverse increases and absence of complications, and an easier surgical approach, with better compliance from these young patients. World J Orthod 2003;4:126–134.