The transpalatal distractor is a bone-borne device that should eliminate negative orthodontic side-effects of tooth-borne devices. The literature contains reports of several possible complications of the transpalatal distractor. In this retrospective study its use was evaluated in ten patients with various congenital craniofacial anomalies, including clefts. During placement of the transpalatal distractor it was noted that in extremely narrow maxillae the palatal bone is very thin, which makes the initial placement difficult and therefore less primary stability can be obtained. There is often a thick palatal mucosa, which makes placement of the abutment plates difficult and leaves hardly any space for the module itself. Finally, in patients with mental retardation it is difficult to exchange modules and re-fix abutment plates. In our group of ten patients with congenital deformities a 60% complication rate was observed. The transpalatal distractor seems not to be the ideal device for use in widening the maxilla in cases with congenital deformities.